Indicators for School Health Programs:
to support Coordinated School Health Programs (CSHPs) and to address Physical Activity, Nutrition, and Tobacco Use (PANT)

Fiscal Year: March 1, 2008 – February 28, 2009
Division of Adolescent and School Health

Funding Opportunity Number: CDC-RFA-DP08-801:
Improving Health and Educational Outcomes of Young People



Instructions

This set of indicators describes the performance in ten areas of your project to support Coordinated School Health Programs (CSHP): (1) project planning; (2) joint activities of the State Education Agency and State Health Agency; (3) activities of state-level coalitions to support CSHP at the local level; (4) CSHP, physical activity, nutrition, and tobacco-use prevention policies; (5) curricula and instruction; (6) assessment of student performance; (7) health promotion and environmental approaches; (8) external collaboration; (9) reducing health disparities among populations of youth at disproportionate risk for chronic diseases; and (10) other information and activities. 
	
A glossary of terms is included at the end of the Indicators.

Activities to be reported are those for which any amount of DASH funds were used, or in which staff time to develop, implement, or evaluate activities was funded in any amount by DASH. These questions apply only to priority health risk behaviors addressed in Funding Opportunity Announcement DP08-801, excluding supplementary funding.  

Please answer each question carefully and accurately.  Not all items or activities may reflect the emphasis of your plan for the current fiscal year, and therefore you may report that you have not performed activities in those areas by entering zeros.  Additionally, you may not currently collect information about some activities.  If so, please leave the answer blank.  Please be sure to include materials for those items requesting attachments. 

Public reporting burden of this collection of information is estimated to average 9 hours per response, including the time reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS-D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0672).

For further questions or assistance with completing this report, 
please contact your CDC project officer.

Person completing the Indicators:

Name:____________________________________________________________________________

Title:_____________________________________________________________________________

State:_____________________________________    Phone:________________________________

Email:____________________________________________________________________________
 


I. PROJECT PLANNING

1.	How many school districts do you have in your state? ______ TOTAL

2.	How many schools do you have in your state? ______ TOTAL 
	
3. 	How many regional support units do you have in your state? ______ TOTAL

4.	In FY 2008, which of the following planning and evaluation activities did your project carry out?  
	A.	Conduct or review Program Inventory	
			YES	NO
	B.	Develop or revise a five-year strategic plan 	
			YES	NO
	C.	Conduct formative evaluation   	
			YES	NO
	D.	Create or revise a logic model	
			YES	NO
	E.	Write SMART objectives	
			YES	NO
	F.	Conduct process evaluation	
			YES	NO
	G.	Conduct outcome evaluation	
			YES	NO
	H.  	Select or review School-Level Impact Measures (SLIMs) 	
			YES	NO
	I.	Develop success stories
			YES	NO
	J.	Other	
			YES	NO
			If YES, Please specify____________________________________


II. JOINT ACTIVITIES OF THE STATE EDUCATION AGENCY (SEA) AND STATE HEALTH AGENCY (SHA)

5.	Currently, does your project employ one staff person at 100% time in the state education agency to serve as the CSHP project director and primary point of contact with DASH?
		YES		
		NO

6.	Currently, does your project employ one staff person at 100% time in the state health agency to serve as the health agency’s CSHP director?
		YES		
		NO

7.	Currently, does your project employ one staff person at 100% time in the state education agency to coordinate programs intended to increase physical activity, improve dietary patterns, and reduce tobacco use among youth through CSHP and support and assist with activities designed to promote CSHP?
		YES		
		NO

8.	During FY 2008, did the SEA and SHA have a formal written agreement to collaboratively develop a state plan to support implementation of CSHP in school districts (e.g., a current memorandum of understanding or contract)?
		YES		
		NO

9. 	During FY 2008, did the SEA and SHA partnership plan include specific activities to:  
	A.	Market or communicate about CSHP (i.e. create awareness or interest in new or on-going CSHP with the general public or partners)
			YES	NO
	B.	Develop or implement CSHP activities		                
			YES	NO
	C.	Develop or change CSHP policy (e.g., statute, model policy, etc.)	
			YES	NO
	D.	Share CSHP resources (e.g., databases, information, programs, etc.)
			YES	NO
	E.	Provide CSHP professional development
			YES	NO
	F.	Evaluate CSHP activities
			YES	NO
	G.	Seek additional funding for CSHP activities	   	  
			YES	NO
	H.	Develop or implement PANT activities		   	  
			YES	NO
	I.	Develop or change PANT policy	                	  
			YES	NO
	J.	Share PANT resources 					   
			YES	NO
	K.	Provide PANT professional development		  
			YES	NO
	L. 	Evaluate PANT activities			   	   
			YES	NO
	M.	Seek additional funding for PANT activities	   	  
			YES	NO


III. ACTIVITIES OF STATE-LEVEL COALITIONS TO SUPPORT CSHPs

10.	Does your state currently have a state-level coalition that supports the coordination of school health programs? 

		YES
		NO - Skip to 15

11.	If so, how many state-level coalitions to support the coordination of school health programs does your state currently have?  
		1
		2 or more

12.	Do any of your state’s state-level coalitions to support the coordination of school health programs have a written plan (e.g., strategic plan, state blueprint, etc.) to develop or strengthen school health programs statewide? 
		YES
		NO - Skip to 14

13. 	How many state-level coalitions to support the coordination of school health programs have written plans to develop or strengthen school health programs statewide?  
		1
        	2 or more

14.	During FY 2008, in which of the following activities have any state-level coalitions to support the coordination of school health programs been involved?
	A.	Implement a CSHP state-level coalition written plan	  
			YES	NO
	B.	Market or communicate about CSHP programs (i.e. create awareness or interest in new or on-going	CSHP programs with the general public or partners)
			YES	NO
	C.	Develop or implement CSHP activities		   	  
			YES	NO
	D.	Develop, change, or advise on CSHP policy (e.g., statute, model policy, etc.)		  	
			YES	NO
	E.	Share CSHP resources (e.g., databases, information, programs, etc.)	 
			YES	NO
	F.	Provide CSHP professional development    	   	
			YES	NO
	G.	Provide incentives (including financial) to develop or implement CSHP activities			   	   
			YES	NO
	H.	Seek additional funding for CSHP activities
			YES	NO
	I.  	Develop or implement PANT activities			   
			YES	NO
	J.	Develop, change, or advise on PANT policy (e.g., statute, model policy, etc.)		  	
			YES	NO
	K.	Share PANT resources (e.g., databases, information, programs, etc.)	  	
			YES	NO
	L.	Provide PANT professional development    	   	  		
			YES	NO
	M.	Provide incentives (including financial) to develop or implement PANT activities			   	
			YES	NO
	N.	Seek additional funding for PANT activities	   
			YES	NO

15.	During FY 2008, did your project have any funding other than DASH funding for state-level activities consistent with those planned by state-level coalitions to support the coordination of school health programs? (May include federal, state, and/or private funding)  (Choose one.)
		YES
		NO - Skip to 16

		If YES:
		a. 	What is the total dollar amount of the funding you received other than DASH funding for state-wide activities consistent with those planned by state-level coalitions to support the coordination of school health programs?  (Please include federal, state, and private funding):  $__________

16.	During FY 2008, did your project obtain any additional funding for state-level CSHP activities consistent with those planned by state-level coalitions to support the coordination of school health programs because of your DASH activities and plans? (May include federal, state, or private funding)  (Choose one.)
		YES
		NO
	

IV. POLICY

17.	During FY 2008, did your project participate in any of the following activities on policy for CSHP, physical activity, nutrition, or tobacco-use prevention?

	A.	DEVELOP (or revise or assist in developing) model policies, policy guidance, or other policy materials to inform policy direction?  
		   (Choose one for each category)			
			for CSHP
				YES
				NO, we have such materials but did not develop them this fiscal year
				NO, we do not have such materials
			for PHYSICAL ACTIVITY
				YES
				NO, we have such materials but did not develop them this fiscal year
				NO, we do not have such materials
			for NUTRITION
				YES
				NO, we have such materials but did not develop them this fiscal year
				NO, we do not have such materials
			for TOBACCO USE PREVENTION
				YES
				NO, we have such materials but did not develop them this fiscal year
				NO, we do not have such materials


	B.	DISTRIBUTE to district or school staff established or model policies, policy guidance, or other policy materials to inform policy direction.
		   (Choose one for each category)			
			for CSHP
				YES
				NO 

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.	Number of hits on policy web pages______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
				6.	Number of external agency partners reached directly______
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.	Number of hits on policy web pages______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
				6.	Number of external agency partners reached directly______
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.	Number of hits on policy web pages______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
				6.	Number of external agency partners reached directly______
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.	Number of hits on policy web pages______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
				6.	Number of external agency partners reached directly______

	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on established or model policies, policy guidance, or other policy materials to inform policy direction.
			for CSHP
				YES
				NO 

				If YES, provide the total:
				1.	Number of professional development events including policy issues______
				2.	Number of participants in professional  development events including policy issues______
				3.	Number of professional development events including policy issues for which you conducted follow-up support______
				4.	Number of schools reached directly______
				5.	Number of districts reached directly______
				6.	Number of regional support units reached directly______
				7.	Number of external agency partners reached directly______	
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.	Number of professional development events including policy issues______
				2.	Number of participants in professional  development events including policy issues______
				3.	Number of professional development events including policy issues for which you conducted follow-up support______
				4.	Number of schools reached directly______
				5.	Number of districts reached directly______
				6.	Number of regional support units reached directly______
				7.	Number of external agency partners reached directly______	
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.	Number of professional development events including policy issues______
				2.	Number of participants in professional  development events including policy issues______
				3.	Number of professional development events including policy issues for which you conducted follow-up support______
				4.	Number of schools reached directly______
				5.	Number of districts reached directly______
				6.	Number of regional support units reached directly______
				7.	Number of external agency partners reached directly______	
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.	Number of professional development events including policy issues______
				2.	Number of participants in professional  development events including policy issues______
				3.	Number of professional development events including policy issues for which you conducted follow-up support______
				4.	Number of schools reached directly______
				5.	Number of districts reached directly______
				6.	Number of regional support units reached directly______
				7.	Number of external agency partners reached directly______	


	D.	Provide TECHNICAL ASSISTANCE to district or school staff on established or model policies, policy guidance, or other policy materials to inform policy direction.
			for CSHP
				YES
				NO 

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______

	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on model policies, policy guidance, or other policy materials to inform policy direction?  (Mark all that apply.)

		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________
	
	
	F.   	Assist district or school staff in policy development or policy implementation on the following topics.  (Assistance to districts or schools may be through distributing materials on policy, professional development, or providing technical assistance.) 
  
		Coordinated School Health Programs
			1. Coordinating school health programs
				YES	NO
			2. Implementing CSHP components	
				YES	NO
			3. Integrating the school health plan into the overall school improvement plan
				YES	NO
			4. Creating, improving, or maintaining school health councils and school health teams	
				YES	NO
			5. Establishing and determining qualifications for and duties of local district CSHP coordinators	
				YES	NO
			6. Developing wellness policies	
				YES	NO
			7. Implementing wellness policies	
				YES	NO
		Health Education	
			1. Implementing or revising time and graduation requirements for K-12 health education classes	
				YES	NO
			2. Implementing or revising certification requirements for teachers of health education 	
			YES	NO
			3. Providing nutrition education for students	
				YES	NO
			4. Incorporating physical activity for students as a required topic within health education	
				YES	NO
			5. Providing tobacco-use prevention education for students	
				YES	NO
			6. Other health education topics (specify):__________________________________
				YES	NO
		Physical Education Policies	             
			1. Implementing or revising time and graduation requirements for K-12 physical education	
				YES	NO
			2. Implementing or revising certification requirements for physical education teachers	
				YES	NO
			3. Prohibiting use of physical activity as a punishment during physical education class	
				YES	NO
			4. Prohibiting exemptions or waivers for physical education participation for participation in other activities	
				YES	NO
			5. Other physical education topics (specify):____________________________
				YES	NO
		Physical Activity Policies	
			1. Providing daily recess for elementary school students 
				YES	NO
			2. Providing physical activity breaks for elementary school students	
				YES	NO
			3. Prohibiting denying recess as a punishment	
				YES	NO
			4. Providing opportunities for after-school physical activity and/or intramurals and/or interscholastic sports	
				YES	NO
			5. Other physical activity topics (specify):_____________________________
				YES	NO
		Healthy Eating Policies	             
			1. Promoting access to and participation in school meals for all students	
				YES	NO
			2. Regulating nutritional quality of all foods and beverages provided on school campuses
				YES	NO
			3. Limiting student access to unhealthy foods or beverages outside of the federally regulated school meals program	
				YES	NO
			4. Requiring nutrition standards for all foods or beverages provided outside of the federally regulated school meals program
				YES	NO
			5. Promoting school fund-raising campaigns that consist of non-food items or healthful foods	
				YES	NO
			6. Implementing or revising classroom guidelines that discourage the use of food as a reward or punishment   	
				YES	NO
			7. Actively promoting fruits and vegetables, whole grain foods, and low/non-fat dairy products to students	
				YES	NO
			8. Prohibiting all forms of advertising and promotion (e.g., contests and coupons) of less nutritious foods and beverages on school property. 	 
				YES	NO
			9. Other healthy eating topics (specify):_________________________________
				YES	NO
		Tobacco-use Prevention Policies
			1. Prohibiting use of tobacco products by students, staff, parents, and visitors on school property, in school vehicles, and at school-sponsored functions away from school property, thereby eliminating exposure to secondhand smoke	        
				YES	NO
			2. Prohibiting tobacco advertising in school buildings, at school functions, or in school publications
				YES	NO
			3. Providing tobacco-use cessation programs or referrals for students or staff 
				YES	NO
			4. Enforcing tobacco-use prevention policies	
				YES	NO
			5. Other tobacco-use prevention/cessation topics (specify): __________________________	
				YES	NO


V. CURRICULA & INSTRUCTION

18.	During FY 2008, did your project participate in any of the following activities on curriculum and instruction for physical education?

	A.	DEVELOP (or revise or assist in developing) physical education standards, curriculum frameworks, instructional strategies, or other guidance?  
			YES
			NO—we have physical education standards, curriculum frameworks, instructional strategies or other guidance, but did not develop them this fiscal year.
			NO—we do not have physical education standards, curriculum frameworks, instructional strategies, or other guidance. 
	
	B.	DISTRIBUTE to district or school staff physical education standards, curriculum frameworks, instructional strategies, or other guidance.  (Choose one.)
			YES
			NO - Skip to 18C

			If YES, provide the total:
			1.	Number of schools reached directly ______ 		
			2.	Number of districts reached directly ______	
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______
			5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) ______

	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on physical education standards, curriculum frameworks, or instructional strategies. 

			YES
			NO - Skip to 18D

			If YES, provide the total:
			1.	Number of professional development events including curricula, curricular standards, frameworks, instructional strategies, or other guidance ______
			2.	Number of participants in professional development events including  curricula, curricular standards, frameworks, instructional strategies, or other guidance ______
			3.	Number of professional development events including curricula, curricular standards, frameworks, instructional strategies, or other guidance for which you conducted follow-up support? ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly ______
			7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff on physical education curriculum and/or instruction (e.g., help in reviewing, revising, developing, or selecting curricula and/or instructional materials). 

			YES
			NO - Skip to 18E

			If YES, provide the total:
			1.	Number of schools reached directly ______	
			2.	Number of districts reached directly ______	
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______
	
	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on physical education curricular standards, frameworks, or instructional strategies? (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

19. 	During FY 2008, did your project participate in any of the following activities to help district or school staff to assess, plan, or coordinate physical education programs?
	
	A.	DISTRIBUTE to district or school staff the Physical Education Curriculum Analysis Tool (PECAT) to help analyze and plan physical education curricula.
			YES
			NO

	B.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on the PECAT to help analyze and plan physical education curricula. 

			YES
			NO - Skip to 19C

			If YES, provide the total:
			1.	Number of professional development events ______
			2.	Number of participants in professional development events ______ 
			3.	Number of professional development events for which you conducted follow-up support ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly ______
			7.	Number of external agency partners reached directly ______

	C.	Provide TECHNICAL ASSISTANCE to district or school staff on the PECAT to help analyze and plan physical education curricula.

			YES
			NO - Skip to 19D

			If YES, provide the total:
			1.	Number of schools reached directly ______
			2.	Number of districts reached directly ______
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______

	D.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on the PECAT to help analyze and plan physical education curricula?  (Mark all that apply.)

		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

20.	During FY 2008, did your project participate in any of the following activities on curriculum and instruction to address content areas of physical activity, nutrition, or tobacco-use prevention in health education?

	A.	DEVELOP (or revise or assist in developing) health education curricula, health education standards, frameworks, instructional strategies, or other guidance?  
			YES
			NO——we have curricula, standards, frameworks, instructional strategies, or other guidance, but have not developed them this fiscal year.
			NO—we do not have such curricula, standards, frameworks, instructional strategies, or other guidance 

	B.          DISTRIBUTE to district or school staff health education curricula, health education standards, frameworks, instructional strategies, or other guidance. 
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
				5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used)______

	C.     	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on health education curricula, health education standards, frameworks, instructional strategies, or other guidance. 
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.  Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				2.  Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				3.  Number of professional development events for which you conducted follow-up support______
				4.  Number of schools reached directly______
				5.  Number of districts reached directly______
				6.  Number of regional support units reached directly______
				7.  Number of external agency partners reached directly______ 	
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.  Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				2.  Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				3.  Number of professional development events for which you conducted follow-up support______
				4.  Number of schools reached directly______
				5.  Number of districts reached directly______
				6.  Number of regional support units reached directly______
				7.  Number of external agency partners reached directly______ 	
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.  Number of professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				2.  Number of participants in professional development events including curricular standards, frameworks, instructional strategies, or other guidance______
				3.  Number of professional development events for which you conducted follow-up support______
				4.  Number of schools reached directly______
				5.  Number of districts reached directly______
				6.  Number of regional support units reached directly______
				7.  Number of external agency partners reached directly______ 	

	D.  	Provide TECHNICAL ASSISTANCE to district or school staff on health education curriculum or instruction (e.g., help in reviewing, revising, developing, or selecting instructional materials). 
			for PHYSICAL ACTIVITY
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
			for NUTRITION
				YES
				NO
			
				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______
			for TOBACCO USE PREVENTION
				YES
				NO

				If YES, provide the total:
				1.	Number of schools reached directly______
				2.	Number of districts reached directly______
				3.	Number of regional support units reached directly______
				4.   	Number of external agency partners reached directly______

	E.     	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE to district or school staff on health education curriculum or instruction (e.g., help in reviewing, revising, developing, or selecting instructional materials)?  (Mark all that apply.)
			for PHYSICAL ACTIVITY
				__Not Applicable – We did not reach external agency partners.
				__Faith-based organizations
				__Health care providers/physicians
				__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				__Legislators/lawmakers
				__Local- or county-level health agencies/departments of health
				__National non-governmental organizations (NGOs) (including local affiliates)
				__Parents/guardians/caregivers (including those reached through PTAs/PTOs)
				__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
				__Social service agencies
				__Universities/colleges/institutions of higher education
				__Youth-serving organizations
				__Other – Please specify type______________________	
			for NUTRITION
				__Not Applicable – We did not reach external agency partners.
				__Faith-based organizations
				__Health care providers/physicians
				__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				__Legislators/lawmakers
				__Local- or county-level health agencies/departments of health
				__National non-governmental organizations (NGOs) (including local affiliates)
				__Parents/guardians/caregivers (including those reached through PTAs/PTOs)
				__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
				__Social service agencies
				__Universities/colleges/institutions of higher education
				__Youth-serving organizations
				__Other – Please specify type______________________	
			for TOBACCO USE PREVENTION
				__Not Applicable – We did not reach external agency partners.
				__Faith-based organizations
				__Health care providers/physicians
				__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				__Legislators/lawmakers
				__Local- or county-level health agencies/departments of health
				__National non-governmental organizations (NGOs) (including local affiliates)
				__Parents/guardians/caregivers (including those reached through PTAs/PTOs)
				__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
				__Social service agencies
				__Universities/colleges/institutions of higher education
				__Youth-serving organizations
				__Other – Please specify type______________________	

21. 	During FY 2008, did your project participate in any of the following activities to help district or school staff to assess, plan, or coordinate health education programs?

	A.	DISTRIBUTE to district or school staff the Health Education Curriculum Analysis Tool (HECAT) to help analyze and plan health education curricula.

			YES
			NO

	B.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on the HECAT to help analyze and plan health education curricula. 

			YES
			NO - Skip to 21C
			
			If YES, provide the total:
			1.	Number of professional development events ______
			2.	Number of participants in professional development events ______ 
			3.	Number of professional development events for which you conducted follow-up support ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly ______
			7.	Number of external agency partners reached directly ______

	C.	Provide TECHNICAL ASSISTANCE to district or school staff on the HECAT to help analyze and plan health education curricula.

			YES
			NO - Skip to 21D

			If YES, provide the total:
			1.	Number of schools reached directly ______
			2.	Number of districts reached directly ______
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______

	D.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on the HECAT to help analyze and plan health education curricula?  (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________


VI. ASSESSMENT OF STUDENT PERFORMANCE

22.	During FY 2008, did your project participate in any of the following activities on the assessment of student performance for physical education?

	A.	DEVELOP (or revise or assist in developing) physical education frameworks or guidance for district or school staff about how to assess or measure students’ knowledge, skills, and physical activity behaviors?  
			YES
			NO—we have physical education frameworks or guidance about how to assess or measure students’ knowledge and skills, but have not developed them this fiscal year.
			NO—we do not have physical education frameworks or guidance about how to assess or measure students’ knowledge and skills. 

	B.	DISTRIBUTE to district or school staff physical education frameworks or guidance about how to assess or measure students’ knowledge, skills, and physical activity behavior? (Do not include materials on how to conduct the Youth Risk Behavior Survey or the School Health Profiles or materials on height or weight measurements.)  
			YES
			NO - Skip to 22C

			If YES, provide the total:
			1.	Number of schools reached directly ______ 	
			2.	Number of districts reached directly ______	
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______	
			5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) ______

	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on how to assess or measure in physical education students’ knowledge, skills, and physical activity behavior.

			YES
			NO - Skip to 22D

			If YES, provide the total:
			1.	Number of professional development events on how to assess or measure in physical education students’ knowledge, skills, and physical activity behavior ______ 	
			2.	Number of participants in professional development events on how to assess or measure in physical education students’ knowledge, skills, and physical activity behavior ______
			3.	Number of professional development events on how to assess or measure in physical education students’ knowledge, skills, and physical activity behavior for which you conducted follow-up support ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly  ______
			7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff on how to assess or measure in physical education students’ knowledge, skills and physical activity behavior.

			YES
			NO - Skip to 22E
	
			If YES, provide the total:
			1.	Number of schools reached directly ______	
			2.	Number of districts reached directly ______
			3.	Number of regional support units reached directly ______	
			4.	Number of external agency partners reached directly ______
	
	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on physical education frameworks or guidance about how to assess or measure students’ knowledge, skills, and physical activity behavior?  (Mark all that apply.)

		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

23.	During FY 2008, did your project participate in any of the following activities on the assessment of student performance for physical activity, nutrition, or tobacco-use prevention in health education?
	
	A.	DEVELOP (or revise or assist in developing) health education frameworks or guidance about how to assess or measure students’ knowledge and skills in physical activity, nutrition, or tobacco-use prevention to district or school staff?  
			YES
			NO—we have health education frameworks or guidance about how to assess or measure students’ knowledge and skills in physical activity, nutrition, or tobacco-use prevention, but have not developed them this fiscal year.
			NO—we do not have health education frameworks or guidance about how to assess or measure students’ knowledge and skills in physical activity, nutrition, or tobacco-use prevention. 

	B.  	DISTRIBUTE to district or school staff health education frameworks or guidance about how to assess or measure students’ knowledge and skills in physical activity, nutrition, or tobacco-use prevention?  (Do not include materials on how to conduct the Youth Risk Behavior Survey or the School Health Profiles.)  
			YES
			NO - Skip to 23C

			If YES, provide the total:
			1.	Number of schools reached directly ______ 	
			2.	Number of districts reached directly ______
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______	
			5.	Number of listservs, Internet mailing lists, or discussion boards used (do not list number of e-mails posted but the number of electronic distribution lists used) ______

	C.  	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on how to assess or measure students’ knowledge and skills relevant to physical activity, nutrition, or tobacco-use prevention in health education.
			YES
			NO - Skip to 23D

			If YES, provide the total:
			1.	Number of professional development events on how to assess or measure students’ knowledge and skills relevant to physical activity, nutrition, or tobacco-use prevention in health education ______
			2.	Number of participants in professional development events on how to assess or measure students’ knowledge and skills relevant to physical activity, nutrition, or tobacco-use prevention in health education ______
			3.	Number of professional development events on how to assess or measure students’ knowledge and skills relevant to physical activity, nutrition, or tobacco-use prevention in health education for which you conducted follow-up support ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly ______
			7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff on assessment or measurement of students’ knowledge and skills for physical activity, nutrition, or tobacco-use prevention in health education.
	
			YES
			NO - Skip to 23E

			If YES, provide the total:
			1.	Number of schools reached directly ______	
			2.	Number of districts reached directly ______
			3.	Number of regional support units reached directly ______ 	
			4.	Number of external agency partners reached directly ______

	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on health education frameworks or guidance about how to assess or measure students’ knowledge and skills in physical activity, nutrition, or tobacco-use prevention?  (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________


VII. HEALTH PROMOTION AND ENVIRONMENTAL APPROACHES

24.	During FY 2008, did your project participate in any of the following activities to help district or school staff to assess, plan, or coordinate school health programs?

	A.	DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to coordinate school health programs or promote PANT through any of the following:
	     	(Choose one for each program topic)
		A. District-level school health councils
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		B. School-level school health councils
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		C. School health coordinators
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		D. Securing administrative support for CSHP	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		E. Collaborating with community partners	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		F. Developing new health-related policies in the context of CSHP	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
	B.	DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to coordinate school health programs through any of the following: 
		A.	District-level school health councils
				YES	NO
		B.	School-level school health councils
				YES	NO
		C.	School health coordinators	
				YES	NO
		D.	Securing administrative support for CSHP
				YES	NO
		E.	Collaborating with community partners 	
				YES	NO
		F.	Developing new health-related policies in the context of CSHP
				YES	NO

 		(If NO to all of the above, skip to 24C.)		
						
		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______ 	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______
		4.	Number of external agency partners reached directly ______	

	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to coordinate school health programs through any of the following:
		A.	District-level school health councils		
				YES	NO
		B.	School-level school health councils	
				YES	NO
		C.	School health coordinators	
				YES	NO
		D.	Securing administrative support for CSHP	
				YES	NO
		E.	Collaborating with community partners  	
				YES	NO
		F.	Developing new health-related policies in the context of CSHP	
				YES	NO

		(If NO to all of the above, skip to 24D.)

		If YES to any of the above, provide the total: 
		1.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials ______	
		2.	Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials ______
		3.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials for which you conducted follow-up support ______
		4.	Number of schools reached directly ______	
		5.	Number of districts reached directly ______
		6.	Number of regional support units reached directly ______
		7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff to coordinate school health programs (i.e. developing model programs or selecting resource materials) through any of the following:
		A.	District-level school health councils		
				YES	NO
		B.	School-level school health councils
				YES	NO
		C.	School health coordinators
				YES	NO
		D.	Securing administrative support for CSHP
				YES	NO
		E.	Collaborating with community partners	
				YES	NO
		F.	Developing new health-related policies in the context of CSHP	
				YES	NO

		(If NO to all of the above, skip to 24E.)

		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______	
		4.	Number of external agency partners reached directly ______

	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE to coordinate school health programs?  (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

25.	During FY 2008, did your project participate in any of the following activities to help district or school staff to assess, plan, or coordinate school health programs?

	A.	DISTRIBUTE to district or school staff the School Health Index or similar tool to help schools assess, plan, or coordinate health programs.

			YES
			NO - Skip to 25B

		If YES, what tool(s) were distributed? (Choose all that apply.)

			The School Health Index
			Other, Please specify_____________________________________

	B.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on the School Health Index or similar tool to help schools assess, plan, or coordinate health programs. 

			YES
			NO - Skip to 25C

			If YES, provide the total:
			1.	Number of professional development events ______
			2.	Number of participants in professional development events ______
			3.	Number of professional development events for which you provided follow-up support ______
			4.	Number of schools reached directly ______
			5.	Number of districts reached directly ______
			6.	Number of regional support units reached directly ______
			7.	Number of external agency partners reached directly ______

	C.	Provide TECHNICAL ASSISTANCE to district or school staff on the School Health Index or similar tool to help schools assess, plan, or coordinate health programs.

			YES
			NO - Skip to 25D

			If YES, provide the total:
			1.	Number of schools reached directly ______
			2.	Number of districts reached directly ______ 
			3.	Number of regional support units reached directly ______
			4.	Number of external agency partners reached directly ______

	D.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE on the School Health Index or similar tool to help schools assess, plan, or coordinate health programs?  (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Cooperative extension service
		__Faith-based organizations
		__Health care providers/physicians
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

26.	Did your project help district staff to assess, plan, or coordinate school health programs using the Healthy School Report Card or similar tool?

		YES
		NO - Skip to 27

		If YES, what tool(s) did you use? (Choose all that apply.)

			The Healthy School Report Card
			Other, Please specify_____________________________________
		
27. 	During FY 2008, did your project engage in any of the following activities to help district or school staff promote physical activity?

	A.	DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to promote physical activity through any of the following:
		(Choose one for each program topic)	

		A. Increasing physical activity opportunities during school-day breaks	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		B. Increasing physical activity opportunities during recess
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		C. Planning or implementing walk-to-school initiatives	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		D. Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural or physical activity clubs, and other after school activities)
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year	
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials

	B.	DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity through any of the following: 
		A.	Increasing physical activity opportunities during school-day breaks
				YES	NO
		B.	Increasing physical activity opportunities during recess		   
				YES	NO
		C.	Planning or implementing walk-to-school initiatives		   
				YES	NO
		D.	Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural or physical activity clubs, and other after school activities)							  
				YES	NO
		
		(If NO to all of the above, skip to 27C.)					

		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______ 	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______
		4.	Number of external agency partners reached directly ______	

	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity through any of the following:
		A.	Increasing physical activity opportunities during school-day breaks								   	   
				YES	NO
		B.	Increasing physical activity opportunities during recess		   
				YES	NO
		C.	Planning or implementing walk-to-school initiatives		   
				YES	NO
		D.	Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural or physical activity clubs, and other after school activities)							  
				YES	NO
		(If NO to all of the above, skip to 27D.)
						
		If YES to any of the above, provide the total: 
		1.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials ______	
		2.	Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials ______
		3.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials for which you conducted follow-up support ______
		4.	Number of schools reached directly ______	
		5.	Number of districts reached directly ______
		6.	Number of regional support units reached directly ______
		7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff to promote physical activity (i.e. developing model programs or selecting resource materials) through any of the following:
		A.	Increasing physical activity opportunities during school-day breaks								   	   
				YES	NO
		B.	Increasing physical activity opportunities during recess		  
				YES	NO
		C.	Planning or implementing walk-to-school initiatives		   
				YES	NO
		D.	Planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural or physical activity clubs, and other after school activities)							   
				YES	NO
		
		(If NO to all of the above, skip to 27E.)

		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______	
		4.	Number of external agency partners reached directly ______

	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE to coordinate school health programs?  (Mark all that apply.)

		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

28.	During FY 2008, did your project engage in any of the following activities to help district or school staff promote healthy eating?
	
	A.	DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not including policy materials) for district or school staff to promote healthy eating through any of the following:
		(Choose one for each program topic)	

		A. Improving nutritional quality of school meals	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		B. Marketing healthy school meals	
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		C. Improving the nutritional quality of school food and beverages provided outside of school meals (e.g., vending machines and a la carte)			
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
		D. Marketing healthy school food and beverage choices provided outside of school meals (e.g., vending machines, classroom snacks, a la carte)
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials
	
	B.	DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not including policy materials) to promote healthy eating through any of the following:
		A.	Improving nutritional quality of school meals			   
				YES	NO
		B.	Marketing healthy school meals					   
				YES	NO
		C.	Improving the nutritional quality of school food and beverages provided outside of school meals (e.g., vending machines and a la carte)
				YES	NO
		D.	Marketing healthy school food and beverage choices provided outside of school meals (e.g., vending machines, classroom snacks, a la carte)
				YES	NO
 
		(If NO to all of the above, skip to 28C.)
				
		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______ 	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______
		4.	Number of external agency partners reached directly ______	
	
	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote healthy eating through any of the following:
		A.	Improving nutritional quality of school meals			
				YES	NO
		B.	Marketing healthy school meals					
				YES	NO
		C.	Improving the nutritional quality of school food and beverages provided outside of school meals (e.g., vending machines and a la carte)	   
				YES	NO
		D.	Marketing healthy school food and beverage choices provided outside of school meals (e.g., vending machines, classroom snacks, a la carte)					   
				YES	NO

		(If NO to all of the above, skip to 28D.)
		
		If YES to any of the above, provide the total:
	
		1.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials ______	
		2.	Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials ______
		3.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials for which you conducted follow-up support ______
		4.	Number of schools reached directly ______	
		5.	Number of districts reached directly ______
		6.	Number of regional support units reached directly ______
		7.	Number of external agency partners reached directly ______

	D.	Provide TECHNICAL ASSISTANCE to district or school staff to promote healthy eating (e.g., developing model programs or selecting resource materials) through any of the following:																			YES	 NO
		A.	Improving nutritional quality of school meals			
				YES	NO	
		B.	Marketing healthy school meals						
				YES	NO
		C.	Improving the nutritional quality of school food and beverages provided outside of school meals (e.g., vending machines and a la carte)	
				YES	NO
		D.	Marketing healthy school food and beverage choices provided outside of school meals (e.g., vending machines, classroom snacks, a la carte)				
				YES	NO		

		(If NO to all of above, skip to 28E.)

		If YES to any of the above, provide the total:
		1.	Number of schools reached directly ______	
		2.	Number of districts reached directly ______	
		3.	Number of regional support units reached directly ______	
		4.	Number of external agency partners reached directly ______

	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE to coordinate school health programs?  (Mark all that apply.)

		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________

29.	During FY 2008, did your project engage in the following activities to help district or school staff promote a tobacco-free lifestyle?

	A. 	DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) for district or school staff to plan and implement tobacco-use prevention programs for students.		
			YES	
			NO—we have model programs, guidance, implementation strategies, or other resource materials, but have not developed them this fiscal year
			NO—we do not have model programs, guidance, implementation strategies, or other resource materials 

	B.	DISTRIBUTE to district or school staff model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to help plan and implement tobacco-use prevention programs for students.			
			YES	
			NO - Skip to 29C

			If YES to any of the above, provide the total:
			1.	Number of schools reached directly  ___________ 	
			2.	Number of districts reached directly  ___________ 	
			3.	Number of regional support units reached directly ________ 	
			4.	Number of external partners reached directly   ______
	
	C.	Provide PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to help plan and implement tobacco-use prevention programs for students.	
			YES	
			NO - Skip to 29D
 
			If YES to any of the above, provide the total:
			1.	Number of professional development events including model programs, guidance, implementation strategies, or other resource materials  ______ 
			2.	Number of participants in professional development events including model programs, guidance, implementation strategies, or other resource materials ____ 	
			3.	Number of professional developments events including model programs, guidance, implementation strategies, or other resource materials for which you conducted follow-up support  ______
			4.	Number of schools reached directly  ______ 	
			5.	Number of districts reached directly  ______ 	
			6.	Number of regional support units reached directly  _____ 	
			7.	Number of external partners reached directly   ______
	
	D.	Provide TECHNICAL ASSISTANCE to district or school staff (for example in developing model programs or selecting resource materials) to help plan and implement tobacco-use prevention programs for students. 

			YES	
			NO - Skip to 29E

			If YES, provide the total:
			1.	Number of schools reached directly  ___________ 	
			2.	Number of districts reached directly  ___________ 	
			3.	Number of regional support units reached directly ________ 	
			4.	Number of external partners reached directly   ______
	
	E.	If you directly reached external agency partners, to what types of external agency partners did you DISTRIBUTE, provide PROFESSIONAL DEVELOPMENT on, or provide TECHNICAL ASSISTANCE to coordinate school health programs?  (Mark all that apply.)
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________


VIII. EXTERNAL COLLABORATION

30.	During FY 2008, did your project COLLABORATE with any of the following external partners?  (Choose YES or NO for each topic.)
		for CSHP
			A. Agencies serving primarily African American youth	
				YES	NO
			B. Agencies serving primarily Hispanic youth	
				YES	NO
			C. Agencies serving primarily American Indian/Alaskan Native youth	
				YES	NO
			D. Agencies serving primarily Asian/Pacific Islander youth
				YES	NO
			E. Other youth-serving community organizations	
				YES	NO
			F. Businesses	
				YES	NO
			G. Community organizations serving parents and families (this does not include internal school parent groups such as the PTA)
				YES	NO
			H. Cooperative extension service	
				YES	NO
			I.  Education organizations (e.g., advocacy, service, professional, or membership associations)	
				YES	NO
			J. Health organizations  (e.g., advocacy,  service, professional, or membership associations)	
				YES	NO
			K. Faith-based organizations	
				YES	NO
			L. Foundations (private or non-profit)	
				YES	NO
			M. Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics)	
				YES	NO
			N. Health care providers/physicians	
				YES	NO
			O. Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				YES	NO
			P.  Local or county education agencies	
				YES	NO
			Q. Local or county health agencies	
				YES	NO
			R. National non-governmental organizations,  including state and local affiliates
				YES	NO
			S. Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
				YES	NO
			T. Social service agencies	
				YES	NO
			U. State health coalitions or networks	
				YES	NO
			V. Universities & other institutions of higher education
				YES	NO
			W. Youth (representing schools or communities)
				YES	NO
			X. Others (Specify)___________________	
				YES	NO
		for PHYSICAL ACTIVITY
			A. Agencies serving primarily African American youth	
				YES	NO
			B. Agencies serving primarily Hispanic youth	
				YES	NO
			C. Agencies serving primarily American Indian/Alaskan Native youth	
				YES	NO
			D. Agencies serving primarily Asian/Pacific Islander youth
				YES	NO
			E. Other youth-serving community organizations	
				YES	NO
			F. Businesses	
				YES	NO
			G. Community organizations serving parents and families (this does not include internal school parent groups such as the PTA)
				YES	NO
			H. Cooperative extension service	
				YES	NO
			I.  Education organizations (e.g., advocacy, service, professional, or membership associations)	
				YES	NO
			J. Health organizations  (e.g., advocacy,  service, professional, or membership associations)	
				YES	NO
			K. Faith-based organizations	
				YES	NO
			L. Foundations (private or non-profit)	
				YES	NO
			M. Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics)	
				YES	NO
			N. Health care providers/physicians	
				YES	NO
			O. Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				YES	NO
			P.  Local or county education agencies	
				YES	NO
			Q. Local or county health agencies	
				YES	NO
			R. National non-governmental organizations,  including state and local affiliates
				YES	NO
			S. Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
				YES	NO
			T. Social service agencies	
				YES	NO
			U. State health coalitions or networks	
				YES	NO
			V. Universities & other institutions of higher education
				YES	NO
			W. Youth (representing schools or communities)
				YES	NO
			X. Others (Specify)___________________	
				YES	NO
		for NUTRITION
			A. Agencies serving primarily African American youth	
				YES	NO
			B. Agencies serving primarily Hispanic youth	
				YES	NO
			C. Agencies serving primarily American Indian/Alaskan Native youth	
				YES	NO
			D. Agencies serving primarily Asian/Pacific Islander youth
				YES	NO
			E. Other youth-serving community organizations	
				YES	NO
			F. Businesses	
				YES	NO
			G. Community organizations serving parents and families (this does not include internal school parent groups such as the PTA)
				YES	NO
			H. Cooperative extension service	
				YES	NO
			I.  Education organizations (e.g., advocacy, service, professional, or membership associations)	
				YES	NO
			J. Health organizations  (e.g., advocacy,  service, professional, or membership associations)	
				YES	NO
			K. Faith-based organizations	
				YES	NO
			L. Foundations (private or non-profit)	
				YES	NO
			M. Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics)	
				YES	NO
			N. Health care providers/physicians	
				YES	NO
			O. Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				YES	NO
			P.  Local or county education agencies	
				YES	NO
			Q. Local or county health agencies	
				YES	NO
			R. National non-governmental organizations,  including state and local affiliates
				YES	NO
			S. Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
				YES	NO
			T. Social service agencies	
				YES	NO
			U. State health coalitions or networks	
				YES	NO
			V. Universities & other institutions of higher education
				YES	NO
			W. Youth (representing schools or communities)
				YES	NO
			X. Others (Specify)___________________	
				YES	NO
		for TOBACCO-USE PREVENTION
			A. Agencies serving primarily African American youth	
				YES	NO
			B. Agencies serving primarily Hispanic youth	
				YES	NO
			C. Agencies serving primarily American Indian/Alaskan Native youth	
				YES	NO
			D. Agencies serving primarily Asian/Pacific Islander youth
				YES	NO
			E. Other youth-serving community organizations	
				YES	NO
			F. Businesses	
				YES	NO
			G. Community organizations serving parents and families (this does not include internal school parent groups such as the PTA)
				YES	NO
			H. Cooperative extension service	
				YES	NO
			I.  Education organizations (e.g., advocacy, service, professional, or membership associations)	
				YES	NO
			J. Health organizations  (e.g., advocacy,  service, professional, or membership associations)	
				YES	NO
			K. Faith-based organizations	
				YES	NO
			L. Foundations (private or non-profit)	
				YES	NO
			M. Governor’s appointed council to improve the health of youth (this can include overall health of youth or individual health topics)	
				YES	NO
			N. Health care providers/physicians	
				YES	NO
			O. Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
				YES	NO
			P.  Local or county education agencies	
				YES	NO
			Q. Local or county health agencies	
				YES	NO
			R. National non-governmental organizations,  including state and local affiliates
				YES	NO
			S. Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
				YES	NO
			T. Social service agencies	
				YES	NO
			U. State health coalitions or networks	
				YES	NO
			V. Universities & other institutions of higher education
				YES	NO
			W. Youth (representing schools or communities)
				YES	NO
			X. Others (Specify)___________________	
				YES	NO


IX. REDUCING HEALTH DISPARITIES AMONG POPULATIONS OF YOUTH AT DISPROPORTIONATE RISK FOR CHRONIC DISEASES

31.	What kinds of data has your project reviewed to identify youth at disproportionate risk for chronic diseases related to physical inactivity, unhealthy dietary patterns, and tobacco use?
		for PHYSICAL INACTIVITY
			A.  Youth Risk Behavior Survey (YRBS) data
				YES	NO
			B.  Adequate Yearly Progress (AYP) scores	
				YES	NO
			C.  Youth Tobacco Survey (YTS) data	
				YES	NO
			D.  Free and reduced-price lunch data
				YES	NO
			E.  Youth morbidity and mortality data
				YES	NO
			F.  Other state data		
				YES	NO
			G.  Other, Please specify___________________________
				YES	NO
		for UNHEALTHY DIETARY PATTERNS
			A.  Youth Risk Behavior Survey (YRBS) data
				YES	NO
			B.  Adequate Yearly Progress (AYP) scores	
				YES	NO
			C.  Youth Tobacco Survey (YTS) data	
				YES	NO
			D.  Free and reduced-price lunch data
				YES	NO
			E.  Youth morbidity and mortality data
				YES	NO
			F.  Other state data		
				YES	NO
			G.  Other, Please specify___________________________
				YES	NO
		for TOBACCO USE
			A.  Youth Risk Behavior Survey (YRBS) data
				YES	NO
			B.  Adequate Yearly Progress (AYP) scores	
				YES	NO
			C.  Youth Tobacco Survey (YTS) data	
				YES	NO
			D.  Free and reduced-price lunch data
				YES	NO
			E.  Youth morbidity and mortality data
				YES	NO
			F.  Other state data		
				YES	NO
			G.  Other, Please specify___________________________
				YES	NO
	
32.	Which populations of youth has your project identified as being at disproportionate risk for chronic disease?
		Physical Inactivity	
			A.______________________	
			B.______________________	
			C.______________________	
			D.______________________	
		Unhealthy dietary patterns	
			A.______________________	
			B.______________________	
			C.______________________	
			D.______________________	
		Tobacco Use
			A.______________________	
			B.______________________	
			C.______________________	
			D.______________________	

	(If your project did NOT identify populations of youth at disproportionate risk for chronic disease, skip to 38.)					

33.	During FY 2008, what activities did your project conduct to increase the capacity of districts and schools to reach the youth at disproportionate risk for chronic diseases that your project identified?  (Choose all that apply.)
		Partnering with agencies to deliver programs within school settings
		Partnering with agencies to deliver programs outside school settings
		Partnering with health agencies to provide health services to youth in or out of school settings
		Promoting student organizations that reach youth at disproportionate risk for chronic diseases
		Providing programs and services that reach youth at disproportionate risk for chronic diseases
		Other, Please specify______________________________________________________

34.	For the activities conducted during FY 2008 to increase the capacity of districts and schools to reach the youth at disproportionate risk for chronic diseases that your project identified, what topics were included? (Choose all that apply.)
		Identifying strategies to increase youth involvement in programs and services
		Providing culturally or linguistically competent educational programs or services
		Understanding the needs of youth at disproportionate risk for chronic diseases
		Building the skill of school administrators, faculty, or staff to address youth at disproportionate risk for chronic diseases
		Reaching families of youth at disproportionate risk for chronic diseases
		Other, Please specify______________________________________________________
	
35.	During FY 2008, describe the PROFESSIONAL DEVELOPMENT (not to include information sessions) to district or school staff that your project provided that focused on youth at disproportionate risk for chronic diseases that your project identified:  
		A.	Number of professional development events that focused on improving the quality of activities for specific priority populations ______
		B.	Number of participants in professional development events that focused on improving the quality of activities for specific priority populations ____ 	
		C.	Number of professional developments events that focused on improving the quality of activities for specific priority populations for which you conducted follow-up support  ______
		D.	Number of schools reached directly ______
		E.	Number of districts reached directly ______
		F.	Number of regional support units reached directly ______
		G.	Number of external agency partners reached directly ______
	
36.	During FY 2008, describe the TECHNICAL ASSISTANCE to district or school staff that your project provided to reach youth at disproportionate risk for chronic diseases that your project identified:
		A.	Number of schools reached directly ______
		B.	Number of districts reached directly ______
		C.	Number of regional support units reached directly ______
		D.	Number of external agency partners reached directly ______


37.	If you directly reached external agency partners, to what types of external agency partners did you provide PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE related to youth at disproportionate risk for chronic diseases that your project identified?
		__Not Applicable – We did not reach external agency partners.
		__Faith-based organizations
		__Health care providers/physicians
		__Insurance companies (e.g., Blue Cross/Blue Shield, Delta Dental)
		__Legislators/lawmakers
		__Local- or county-level health agencies/departments of health
		__National non-governmental organizations (NGOs) (including local affiliates)
		__Parents/guardians/caregivers (including those reached through PTAs/PTOs)	
		__Professional associations/organizations (e.g., NEA, AAHPERD, ASHA)
		__Social service agencies
		__Universities/colleges/institutions of higher education
		__Youth-serving organizations
		__Other – Please specify type___________________________
	
	
X. OTHER INFORMATION & ACTIVITIES

38.	In FY 2008, did you conduct INFORMATION SESSIONS (not to include professional development) that focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP?
		YES		
		NO - Skip to 39

		If yes:

	A.	How many information sessions did you conduct focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? _____________
	B.	Please check all the topics on which you conducted information sessions in FY 2008:
		___ Physical activity
		___ Physical education
		___ Nutrition
		___ Tobacco-use prevention
		___ Health education
		___ CSHP
		___ Other, Please specify___________________________________________

	C.	Please check all audiences for whom you conducted information sessions in FY 2008:
		___ District-level staff or administrators
		___ School-level staff or administrators
		___ State school board members or superintendent
		___ Staff or students at universities, colleges, or other institutions of higher education
		___ Community-based organization staff
		___ State health officer
		___ State or local health agency staff
		___ State education agency staff
		___ Legislators/lawmakers
		___ Parents/parent groups
		___ School-aged youth
		___ Other, Please specify____________________________________________

39.	In FY 2008, did you provide PRE-SERVICE LEARNING events that focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP?

		YES		
		NO - Skip to 40

		If YES:

		A.	How many pre-service learning events did you provide focused on policy, curriculum, student assessment, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? _____________
		B.	Please check all the topics on which you provided pre-service learning events in FY 2008:
			___ Physical activity
			___ Physical education
			___ Nutrition
			___ Tobacco-use prevention
			___ Health education
			___ CSHP
			___ Other, Please specify___________________________________________

40.	Is there information that we asked for in this year’s Indicators that you estimated or guessed at?
		YES	
		NO - Skip to 41

	A.	What kind of information did you estimate or guess at?  (Mark all that apply.)
		1.	Distribution of print materials
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		2.	Distribution of materials on web sites, listservs, Internet mailing lists, or discussion boards	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		3.	Professional development events	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		4.	Follow-up support for professional development events	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		5.	Technical assistance	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		6.	Funding dollar amounts	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		7.	Information sessions	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		8.	Pre-service learning events
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable

	B.	On what topics did you estimate or guess at information?  (Mark all that apply.)
		1.	Project planning	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		2.	Policies	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		3.	Curricula and instruction	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		4.	Assessment of student performance	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		5.	Health promotion and environmental approaches	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable
		6.	Reducing disparities among youth at disproportionate risk for chronic diseases	
				We DID estimate or guess
				We did NOT estimate or guess
				Not Applicable

41.	Is there information that we asked for in this year’s Indicators that you did not collect at all?
		YES	
		NO - Skip to 42

	A.	What kind of information did you not collect at all?  (Mark all that apply.)
		1.	Distribution of print materials	
				We DID collect
				We did NOT collect
				Not Applicable
		2.	Distribution of materials on web sites, listservs, Internet mailing lists, or discussion boards	
				We DID collect
				We did NOT collect
				Not Applicable
		3.	Professional development events	
				We DID collect
				We did NOT collect
				Not Applicable
		4.	Follow-up support for professional development events	
				We DID collect
				We did NOT collect
				Not Applicable
		5.	Technical assistance	
				We DID collect
				We did NOT collect
				Not Applicable
		6.	Funding dollar amounts	
				We DID collect
				We did NOT collect
				Not Applicable
		7.	Information sessions	
				We DID collect
				We did NOT collect
				Not Applicable
		8.	Pre-service learning events	
				We DID collect
				We did NOT collect
				Not Applicable

	B.	On what topics did you not collect information at all?  (Mark all that apply.)
		1.	Project planning	
				We DID collect
				We did NOT collect
				Not Applicable
		2.	Policies	
				We DID collect
				We did NOT collect
				Not Applicable
		3.	Curricula and instruction
				We DID collect
				We did NOT collect
				Not Applicable
		4.	Assessment of student performance	
				We DID collect
				We did NOT collect
				Not Applicable
		5.	Health promotion and environmental approaches
				We DID collect
				We did NOT collect
				Not Applicable
		6.	Reducing disparities among youth at disproportionate risk for chronic diseases	
				We DID collect
				We did NOT collect
				Not Applicable


42.	Please provide information about any additional activities not captured by the questions above.  In particular, please report on any additional activities to improve physical activity, nutrition, or tobacco-use prevention policies, curriculum, instruction, assessment, collaborations, or CSHP at the local level and any activities for which you could not collect information on participants or recipients of materials.

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


43.	Please provide any additional general comments or information in the space below.

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________




THANK YOU FOR YOUR RESPONSES.  PLEASE RETURN THE INDICATORS.
 




GLOSSARY

Please refer to the following definitions when answering the questions.

ASSESSMENT – Measuring the learning and performance of students or teachers. Different types of assessment instruments include achievement tests, minimum competency tests, developmental screening tests, aptitude tests, observation instruments, performance tasks, and authentic assessments.

COLLABORATE – Two or more partners actively engage in planning, implementing, and evaluating programs, practices, and policy activities with defined roles and responsibilities.

COORDINATED SCHOOL HEALTH PROGRAM (CSHP) – A coordinated school health program is a planned and organized set of courses, services, policies, and interventions designed to meet the health and safety needs of K-12 students. Schools promote optimal physical, emotional, social, and educational development of students by providing health education; physical education; health services; nutrition services; counseling, psychological and social services; and a healthy and safe environment; and by promoting parent/community involvement and staff wellness. A successful and well-coordinated school health program is characterized by administrators, teachers, and school board members who view health protection and promotion as an essential part of the school’s mission; a school health council comprised of school, family, and community representatives to ensure a planning process for continuous improvement; a school health coordinator responsible for organizing and managing the school health program; and school staff who help plan and implement a full array of school health courses, services, policies, and interventions.

COORDINATION – the regulation of diverse elements into an integrated and harmonious operation.

CSHP STATE-WIDE COALITION – A confederation of organizations with similar goals that agree to work together toward a common goal.  People who serve on coalitions, whether professional or volunteer, have obligations to the organization they represent as well as to the coalition.

CURRICULUM – An educational plan incorporating a structured, developmentally appropriate series of intended learning outcomes and associated learning experiences for students; generally organized as a related combination or series of school-based materials, content, and events.

DEVELOPMENT – The process of bringing into being, making active, available, or effective, CSHP-related materials, plans, policies, or activities.

DISTRIBUTE – Putting materials in the hands of appropriate personnel.  Distribution may occur in response to requests for materials or through proactive sharing of information. 

ENVIRONMENTAL APPROACHES – Those policies and programs that are intended to affect physical surroundings and the psychosocial climate and culture of the school. Environmental approaches include policies, programs, and services that reinforce school health education and physical education curricula as well as contribute to health outcomes for students and staff.

EVALUATION PLAN – A written evaluation plan may include process evaluation, to determine if activities were as planned and how well they were conducted, as well as outcome evaluation, to determine the impact of an activity or program on program objectives.

EXTERNAL AGENCY PARTNERS – Agencies, organizations, and groups outside your own agency with which you collaborate or associate to further the goals of your CSHP project.

FISCAL YEAR (FY) – March 1, 2008 to February 28, 2009, the budget period for the cooperative agreement.

FOLLOW-UP SUPPORT – Assistance provided to enhance participants’ abilities to use skills, tools and techniques learned through professional development offerings.  Follow-up support leads to a more significant outcome than training alone by addressing challenges and sharing successes through a variety of media (e.g., e-mail, conference calls, webcasts, site visits).

FORMATIVE EVALUATION – Gathering information during the early stages of your project or program, with a focus on finding out whether your efforts are unfolding as planned, uncovering any obstacles or unexpected opportunities that may have emerged, and identifying adjustments and corrections to your program. 

FRAMEWORK – An outline or plan that presents both the content (e.g., important concepts, skills, and generalizations) and the process for developing curricula, instruction, and assessment.

GUIDANCE – A set of strategies that apply frameworks to develop policies, curricula, instruction, and assessment.

HEALTH EDUCATION – Includes planned sequential materials, instructions, and educational experiences delivered in the classroom setting that provide students with opportunities to acquire the knowledge and skills necessary for making health promoting decisions and achieving health literacy.  Quality health education is based on sound theories of development and behavior change or empirically supportive practices that result in increased knowledge and positive behavior change.

HEALTH EDUCATION CURRICULUM ANALYSIS TOOL (HECAT) – An assessment tool for examining school health education curricula to determine how closely they align with the National Health Education Standards and CDC’s Characteristics of Effective Health Education Curricula. The HECAT helps school districts conduct a clear, complete, and consistent analysis of health education curricula.  The HECAT results can help schools select or develop appropriate and effective health education curricula and improve the delivery of health education.

HEALTHY EATING – Eating behaviors that promote health, growth, and intellectual development; prevent immediate nutrition-related health problems; and reduce risks for long-term chronic diseases (e.g., coronary heart disease, cancer, and stroke).  Healthy eating behaviors include a diet consistent with recommendations from the Dietary Guidelines for Americans http://www.health.gov/dietaryguidelines/. 

HEALTHY SCHOOL REPORT CARD – The Healthy School Report Card (HSRC) is an ASCD Action Tool. This research-based tool was developed to help schools engage stakeholders from the school and community in the assessment of their school environment for inclusion in the school improvement process. The strategies contained in this tool are taken from evidence and best-practices. It can help reveal any high quality programming that is occurring and identify areas that need improvement.  Additional information about the Healthy School Report Card is available at http://www.healthyschoolcommunities.org/HSRC/pages/reportcard/reportcardlogin.aspx. 

IMPLEMENTATION – To put into effect or accomplish plans, policies, or activities related to CSHP projects.

INFORMATION SESSION – Workshop, presentation or other instructional activities delivered in a short period of time taking at least 30 minutes and no more than 3 hours that focuses on a specific public health, curricular or coordinated school health program topic.  Information sessions are tailored to specific audiences such as school administration, faculty, education and health professionals, adolescents, parents, college students, legislators or community groups.

LOGIC MODEL – A logic model is a pictorial diagram that shows the relationship between your program components and activities and desired health outcomes.  A logic model is a planning tool that might describe your entire program or a particular program objective or initiative.  Interactive tutorials on logic models are available at: http://www.cdc.gov/HealthyYouth/evaluation/resources.htm. 

MATERIALS – Resources including written materials (e.g., curricula, training materials, and pamphlets); audio visual materials (e.g., motion pictures and video tapes); pictorials (e.g., posters and similar educational materials using photographs, slides, drawings, or paintings); and electronic resources (e.g., Web sites, PDF files, and PowerPoint files).

MEMORANDUM OF UNDERSTANDING (MOU) – An agreement between agencies specifying the process or procedures for collaborative development of CSHP infrastructure.  May also be called a Memorandum of Agreement.

MODEL POLICY – Model policies provide a framework to assist school officials in developing their own state or local policies. They are written as statements of best practice which can be adapted to fit local circumstances. Model policies reflect state-of-the-art, scientifically reliable information on what constitutes effective school health programs and the expert opinions of many reviewers. Included in model policies are excerpts or references to actual national, state, and local policies; a purpose or goals; rationale; and definitions.

MODEL PROGRAM – A packaged, promising, evidence-based or science-based program that results in positive outcomes.

NUMBER OF DISTRICTS REACHED DIRECTLY – A district is reached directly when one or more district level staff receives materials, training, or assistance from personnel funded by your CSHP project.  Each district reached is counted only once as being reached for a particular topic regardless of the number of district staff from that district are reached or the number of times district staff are reached.

NUMBER OF EXTERNAL AGENCY PARTNERS REACHED DIRECTLY – An external partner is reached directly when one or more external partner’s staff receives materials, training, or assistance from personnel funded by your CSHP project.  Each external partner reached is counted only once as being reached for a particular topic regardless of the number of external partner staff from that external partner are reached or the number of times external partner staff are reached.

NUMBER OF REGIONAL SUPPORT UNITS REACHED DIRECTLY – A regional support unit is reached directly when one or more regional support unit staff receives materials, training, or assistance from personnel funded by your CSHP project.  Each regional support unit  reached is counted only once as being reached for a particular topic regardless of the number of regional support unit staff from that regional support unit are reached or the number of times regional support unit staff are reached.

NUMBER OF SCHOOLS REACHED DIRECTLY – A school is reached directly when one or more school staff receives materials, training, or assistance from personnel funded by your CSHP project.  Each school reached is counted only once as being reached for a particular topic regardless of the number of school staff from that school are reached or the number of times school staff are reached.

NUTRITION – The science or practice of taking in and utilizing foods.

OUTCOME EVALUATION – Evaluation undertaken to determine if the changes ascribed to a program (e.g., changes in systems, collaborations, policies, or knowledge, attitudes, or behavior among administrators, teachers, school staff, community members, or youth) are associated with program activities. 

PARTNERSHIP PLAN – Jointly prepared plans between the state education agency and the state health agency for coordinating administrative responsibilities, establishing reciprocal roles, and complementing school and youth-related health programs across the two agencies.

PHYSICAL ACTIVITY – Any bodily movement produced by skeletal muscles which results in caloric expenditure.  

PHYSICAL ACTIVITY, NUTRITION, AND TOBACCO-USE PREVENTION (PANT)  PROJECT – Any activities or personnel that are funded in part or in whole, through funding opportunity announcement DP08-801 funds for improving health and education outcomes of young people through CSHP with a focus on physical activity, nutrition, and tobacco-use prevention. May include the work of contract staff. 

PHYSICAL EDUCATION – An academic curricular area that implements physical education curricula and instruction that emphasizes enjoyable participation in physical activity, and that helps students develop the knowledge, attitudes, motor skills, behavioral skills, and confidence needed to adopt and maintain physically active lifestyles. 

PHYSICAL EDUCATION CURRICULUM ANALYSIS TOOL (PECAT) – A tool for analyzing written physical education curricula to determine how closely they align with national standards for high-quality physical education.  The PECAT helps school districts conduct a clear, complete, and consistent analysis of physical education curricula. PECAT results can help users enhance, develop, or select appropriate and effective physical education curricula for the delivery of quality physical education, which will improve the ability of schools to positively influence motor skills and physical activity behaviors among school-age youth.

PHYSICAL INACTIVITY – Physical inactivity is categorized as sedentary or insufficient physical activity.

POLICY – Any mandate issued or policies adopted by school district boards of education, the state school board, state legislature, or other district or state agencies that affects the environment in schools throughout the state. These include policies developed by your state or those based on model policies developed elsewhere. Sample model policies for PANT are available in Fit, Healthy, and Ready to Learn: A School Health Policy Guide (March 2004), developed by the National Association of State Boards of Education (NASBE). Sample policies can be viewed at NASBE’s website: http://www.nasbe.org/healthy_schools/policy.htm.

PRE-SERVICE LEARNING – Pre-service learning provides pre-professionals serving youth (e.g., educators, nurses, counselors) with an understanding of the central concepts, tools of inquiry, and structures of relevant disciplines.

PROCESS EVALUATION – Collecting and analyzing data to determine who, what, when, where, and how much of program activities have been conducted.  Process evaluation allows staff to assess how well the program has been implemented.  

PROFESSIONAL DEVELOPMENT – The systematic process used to strengthen the professional knowledge, skills and attitudes of those who serve youth to improve the health, education, and well-being of youth.  Professional development is consciously designed to actively engage learners and includes the planning, design, marketing, delivery, evaluation, and follow-up of professional development offerings (events, information sessions, and technical assistance).

PROFESSIONAL DEVELOPMENT EVENT – A set of skill-building processes and activities designed to assist targeted groups of participants in mastering specific learning objectives. Such events are delivered in an adequate time span (at least 3 hours) and may include curriculum and other training, workshops, conferences, and on-line or distance learning courses.

PROGRAM – A multi-faceted approach to decrease health risk behaviors that may include a combination of strategies such as one-on-one interventions, policy and climate changes, advocacy, peer interventions, mentoring programs, youth asset development, and outreach.

PROGRAM INVENTORY – A document that funded partners are required to fill out in the first and fifth year of the 801 Cooperative Agreement that provides a snapshot of what their program currently is doing or plans to do.

REGIONAL SUPPORT UNITS – A state-recognized agency or organization (e.g., universities, regional education support agencies, regional offices of education, regional training centers, teacher centers, county superintendent’s offices, etc.) that provides professional development, technical assistance, and educational materials to school districts and schools within the state.

SCHOOL – A division of the public school system consisting of students in one or more grades or other identifiable groups organized to give instruction of a defined type. One school may share a building with another school or one school may be housed in several buildings.  Each school usually has an identification number assigned by the state department of education for tracking purposes.  Public schools include charter schools, magnet schools, vocational schools, and alternative schools.

SCHOOL DISTRICT – An education agency at the local level that exists primarily to operate public schools or to contract for public school services. Synonyms include local basic administrative unit, local education agency, parish, independent school districts, etc.

SCHOOL HEALTH COORDINATOR – The professional at the district or school level who is responsible for the management and the coordination of all school health policies, activities, and resources.

SCHOOL HEALTH COUNCIL – A school health council (SHC) guides school programming and enables collaborations between the school and the community to improve students' health and learning. Ideally, the council is comprised of representatives from each of the eight components of a coordinated school health program, as well as parents, students, and other community representatives involved in the health and well-being of students. SHCs establish goals for the school health program and specific priority health issues; facilitate health programming and services in the school and between the school and community; and advocate for effective health policies, programs, and services.

SCHOOL HEALTH INDEX – The School Health Index is a self-assessment and planning tool that enables those who use it to identify the strengths and weaknesses of school health promotion policies and programs; develop an action plan for improving student health; and involve teachers, parents, students, and the community in improving school policies and programs.  More information on the School Health Index is available at: http://www.cdc.gov/healthyyouth/shi.

SCHOOL LEVEL IMPACT MEASURES – The purpose of the School Level Impact Measures (SLIMs) is to provide education agencies with a common set of measures for reporting progress on the implementation of CDC recommended practices and programs.

SERVING PRIMARILY – Agencies whose main focus is on providing services tailored to a specific, identifiable population (e.g., by race, gender, etc.) or increasing the ability of others to provide services to that population.

SMART OBJECTIVES – Objectives are statements that describe program results to be achieved and how they will be achieved.  Specific objectives include who will be targeted and what will be accomplished. Measurable objectives include how much change is expected, specifically enough that achievement of the objective can be measured through counting or documenting change.  Achievable objectives can be realistically accomplished given your program’s existing resources and constraints.  Realistic objectives address the scope of the health problem and propose reasonable programmatic steps. Time-phased objectives provide a timeline indicating when the objective will be met.  

SPECIFICALLY FOCUSED ON – Programs or activities that are tailored to a particular, identifiable population (e.g., by race, gender, etc.) or activities to increase the ability of others to provide such services or activities.

STANDARDS – An established set of written expectations that describe what a student should know (knowledge) and be able to do (skills) as a result of the instruction provided for a particular subject (content area).  Standards provide a framework for curriculum development and selection, instruction, and assessment.
•	Health Education Standards are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health.  An abbreviated version of the National Health Education Standards, Second Edition and Performance Indicators for specific grade level groupings can be found at http://www.cdc.gov/healthyyouth/sher/standards.
•	Physical Education Standards are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 as a result of a quality physical education program.  An abbreviated version of the National Standards for Physical Education, Second Edition, can be found at http://www.aahperd.org/naspe/publications-nationalstandards.html.

STATE EDUCATION AGENCY (SEA) – The department of state or territorial government responsible for public education policy, funding, monitoring, and training within that state or territory.

STATE HEALTH AGENCY (SHA) – The department of state or territorial government responsible for public health policy, funding, monitoring, and training within that state or territory.

STRATEGIC PLAN – A program planning tool that provides a blueprint to strengthen program activities, address areas for improvement, and move the program forward to new accomplishments.

SUCCESS STORIES – A narrative highlighting the achievements and progress of a program or activity.

TECHNICAL ASSISTANCE – Tailored guidance to meet the specific needs of a site or sites through collaborative communication between a specialist and the site(s). Assistance takes into account site-specific circumstances and culture and can be provided through phone, mail, e-mail, Internet, or in-person meetings.

TOBACCO USE – May be defined as the consumption of tobacco or tobacco-related products.  Tobacco is predominantly consumed by inhalation of the smoke produced by items such as cigarettes, cigars, cigarillos, pipes, bidis, and kreteks.  It is also consumed in the form of smokeless tobacco products, such as snuff or chewing tobacco.  This smokeless consumption may occur by directly inhaling a prepared tobacco leaf product into the nostrils, or by sucking and/or chewing a prepared tobacco leaf product.

TOBACCO-USE PREVENTION – Interventions that prevent or delay the initiation of tobacco use or reduce the prevalence of tobacco use, including tobacco-use cessation. Interventions may target individuals or groups of youth, in terms of policy and/or environmental changes and may occur in schools or in partnership with community organizations. Tobacco-use prevention efforts may include activities designed to eliminate exposure to secondhand smoke.

UNHEALTHY DIETARY PATTERNS – Eating behaviors characterized by food intake that is typically high in fat, low in fiber, and low in fruits and vegetables, and are associated with increased risks for long-term chronic diseases (e.g., coronary heart disease, cancer, and stroke).

YOUTH AT DISPROPORTIONATE RISK FOR CHRONIC DISEASE – Populations of youth for whom the incidence, prevalence, mortality, and burden of chronic disease and other related adverse health conditions, many of which result from health-related behaviors that are established during childhood and adolescence, are greater than in a comparison population.  Populations can be defined by race or ethnicity, gender, education or income, disability, geographic location (i.e., rural or urban), or sexual orientation.