January 19 2011

Dear Elementary School Principal

Re Coordinated Approach to Child Health (CATCH) Grant Opportunity

The CATCH Program in New Mexico funded by the New Mexico Diabetes Prevention and Control Program (NMDPCP) is pleased to announce availability of funding of CATCH grants for School Year (SY) 2011-2012 All New Mexico elementary schools are encouraged to apply The application is available online as an electronic PDF fill-in form at wwwdiabetesnmorg (Click on CATCH)

The CATCH grant provides classroom nutrition and PE curricula and resources for kindergarten through 5th grade teachers and a tobacco avoidance curriculum for 5th grade Lesson plans are evidence-based teacher friendly and support your efforts in meeting Health Education and Physical Education Performance Standards Concepts taught in the CATCH nutrition and PE curriculum also support your Wellness Policy and extends the concepts of wellness to parents families and community partners

CATCH funding provides bull Teachers manuals (new teachers only) bull Student workbooks for the classroom curriculum bull Classroom instructional tools and posters bull Training for your school Champion through a two-day CATCH Leadership Institute

in Albuquerque and additional on-site training as needed bull Physical activity equipment for CATCH activities (new schools only) bull Administration support and technical assistance bull Funds for CATCH related student and family activities ranging from $250 to $1800

based upon school size and bull A $500 honorarium for the CATCH Champion

Funding is determined by the Legislature and amounts listed above may have to be adjusted

A CATCH grant based on student population is awarded on a year-to-year basis through a competitive application process The funds are made available as seed money to help your school coordinate and sustain a healthier school environment while you work toward the goal of a self-sustaining CATCH Program through other funding entities and partners The NMDPCP provides funding and technical support for a period of three to five years

As you plan for the coming year please consider using CATCH as a resource to support health education and physical education in your school The NMDPCP is confident that CATCH can provide key support to wellness in your school On behalf of the NMDPCP I look forward to receiving your application

Sincerely

Carol Turner PhD RD LD CATCH Principal Investigator

Maggi Gallaher MD MPH Division Director (Acting) bull Public Health Division 1190 St Francis Dr Suite 1050 bull PO Box 26110 Santa Fe New Mexico 87502

(505) 827-2389 FAX (505) 827-2329 httpwwwnmhealthorg

Coordmated Approach To Child

- Health CATC~

Coordinated Approach To Child Health CATCH 2011-2012 Grant Application

NM Department of Health Diabetes Prevention amp Control Program

School Information Form

bull Only complete applications will be considered bull Completed applications must be e-mailed by midnight May 62011

to Cynthia Conine - cconinenmsuedu bull You will receive an e-mail confirming receipt of your application

Please check one of the following 0 New School 0 Renewing School School year last funded ___

School Name Mesa Elementary School District Central Consolidated Schools

Physical Address North Highway 49 Mesa School Road

Mailing Address _PO_BO_X__80_3___________________

City Shiprock County San Juan

State NM Zip Code _87_4_20______

(505) 368-4529 (505) 368-5765Telephone Fax

Principal Pandora Mike E-mail mikepcentralschoolsorg

Will this principal be atthis school in 2011-2012 _ye_s___

If not who will be principal ___________________

L f C PET hApplication preparer_e__cl_a_r_ls_p_______ Position eac er

I I

Name E-mail Phone

Financial Contact ~yron Manning mannbcentralschoolsorg (505) 598-5834

Food Service Director Brock Smith smitbcentralschoolsorg (505) 598-5966

Wellness Director ~arb Walker walkbcentralschoolsorg (505) 368-4984

School Nursing Director ~arb Walker walkbcentralschoolsorg (505) 368-4984

Deadline Must be emailed by midnight May 6 2011 to cconinenmsuedu

School Information Form (continued)

1 Provide the following demographic data

Student Enrollment Number of classes

K 78 K 4

pt 58 pt 3

2nd 70 2nd 3

3rd 80 3rd 3

4th 59 4th 3

5th 58 5th 3

Ethnic Breakdown Number of students in each category

Hispanic 0

Caucasian (not of Hispanic origin) 0

American IndianNative American 403

Black (not of Hispanic origin) 0

Asian 0

Pacific Islander 0

Other

ercent of Students on Free amp Reduced Lunch 100

2 Does your school servebreakfast in the classroom 0 Yes 0 No If so which grade levels OK 01st 02nd If not would you implementbreakfast in the classroom

03rd 04th 0 Yes

05th 0 No

3 Does your school have recess before lunch If so which grade levels 0 K 01st If not would you implementrecess before lunch

02nd 0 Yes

0 Yes 03rd 04th

0 No

0 No o 5th

4ls your physical education teacher certified to teach PEl o Yes 0 No

5 Is your schools physical education teacher full-time or part-time o Full-Time 0 Part-Time

6 How many minutes per week does each grade level receive physical education K 45 1 st 45 2nd 45 3rd 45 4th45 5th 45

Deadline Must be emailed by midnight May 6 2011 to cconinenmsuedu

School Information Form (continued)

5 days7 How many days is the nurse at your school 75 hoursHow many hours each day

8 Do you have a School Health Advisory Committee (SHAC)Wellness Committee in place ~ Yes ~No

Please type your answer in the space provided Limit each response to 100 words

9 If you answered YESto question 8 describe current activities of your SHAClWeliness Committee (In 100 words or less)

We have provided after school sports for the 3rd-5th grade students We have also purchased t-shirts for all students as a part of school pride Our school hosts monthly family night activities We also provide staff wellness activities such as walking club holiday activities We have monthly spirit week activities and participate in red ribbon week activities We have developed a relation with Navajo Prep schools TUPAC organization (tobacco awareness) and they host a family night at our school We also provide physical activity field trips for all students We use to get funding through the Navajo Coordinated School Health for our school but we no longer receive this funding

10 Describe how you plan to use CATCH to support your schools participation in the school district Well ness Policy (I n 100 words or less)

Our school would like to expand our after school program by providing more activities for all students Since we only have a certain amount of time allotted to PE class we believe that we could get students involved in more physical activity after school We would also like to work more with our kitchen staff and classroom teachers in providing more healthy snacks for the students We believe our school well ness team has a strong base and we believe that we can continue many activities that our former grant covered- Emotional Mental Well ness Physical Activity Staff Well ness Family School Community Partnership Nutrition Health Education SafeHealthy Environment and Health Services

Deadline Must be emailed by midnight May 62011 to cconinenmsuedu

School I nformation Form (continued)

School Principal Commitment Form

1 As principal I am committed to Coordinated School Health Programming in my school

2 I recognize CATCH as a resource that supports coordinated school health of my school my staff and our children

3 I recognize that the New Mexico Department of Health funding for CATCH is

a Subject to available funding

b Contingent upon completion review and acceptance of the program by NMDPCP

c Seed money that may not be funded beyond 3-5 years and

d Must be applied for each year

4 I understand that CATCH requires the following and I agree to actively support and facilitate these activities

a Selection of a CATCH Champion who is responsible for the coordination and successful implementation of CATCH in my school

b Release time for the CATCH Champion at a minimum of one CATCH training and two school committee meetings per school year

c Selection of a CATCH committee (may be current SHACWellness etc) This committee will guide the implementation of the CATCH program in my school

d Implementation of all CATCH components (CATCH requires involvement in CATCH by the entire school including principal teachers food service nurse etc)

i nutrition curriculum to be taught in every class by the classroom teacher (CATCH curriculum aligns with many health education physical education and other academic performance standards)

ii CATCH PE curriculum to be taught by PE teacher(s)

iii school food service involvement

iv home and family involvement

e Use CATCH funds in accordance with the Scope ofWork and CATCH guidelines

f Data collection as needed for the evaluation of CATCH in our school

5 Be visibly involved throughout the school year in my support of CATCH

6 I understand that if I am no longer principal during SY11-12 this application may be reevaluated

Briefly state your vision of how CATCH will benefit the students teachers staff and the parents of your school (in 100 words or less) Mesa Elementary is committed to implementing CATCH for the benefit of our students and community We look forward to establishing a school wellness team to coordinate school events for all to participate in In addition we look forward to implementing the CATCH curriculum to promote better nutrition physical fitness opportunities and healthy family involvement opportunities As a result we plan to learn about ourselves and better ways to live healthy In addition I support Ms Leticia Crisp as a CATCH Champion She will be responsible to coordinate CATCH program for school year 2011-12

By submitting this application I am committing to make CATCH successful in my school

You will be notified July 12011 ifyour school is selected for SY11-12 You will also receive a School Agreement and a Vendor Questionnaire form the first week in October which you will be asked to sign and return

Deadline Must be emailed by midnight May 6 2011 to cconinenmsuedu

School Information Form (continued)

CATCH Committee Form

To fully implement a quality CATCH program it is highly recommended that each school applying for CATCH funds have a representative in each category listed below This may be your schools School Health Advisory Council (SHAC) Wellness Committee or other leadership committee

The Proposed CATCH Committee will be composed of the following

Leticia CrispCATCH Champion

Champion Phone (505) 368-4529 Ch E I crislcentralschoolsorgamplon mal ____________

Please check box if a SHAC member

Name Pandora Mike [ElPrincipal

Name Isabella Shorthair [ElCafeteria Manager

Name Alan Maxwell DParent Representative

Name Leticia Crisp [ElPhysical Education Teacher

Name Myra Yellowhorse [ElSchool Nurse

Name Sharon Natani-Begaye DKindergarten Teacher

1 st Grade Teacher Name Kay Atcitty D

Name Shirleen Rivers D2nd Grade Teacher

Name Maxine Etter D3rd Grade Teacher

Name Judy Geisinger D4th Grade Teacher

Name Dionne Shepard D5th Grade Teacher

Name Joann Begay IE]Other Representative (Counselor community member etc)

A final list of committee members must be submitted to the Field Director at their first site visit

Deadline Must be emailed by midnight May 6 2011 to cconinenmsuedu