Western Dairy Association

1. Name of School (*):
2. Name of District (*):
3. Name of person submitting plan (*):
4. Phone number of person submitting the plan (*):
5. Email of person submitting the plan (*):

1. Name of program advisor (*):
2. Title of program advisor (*):
3. Phone number of program advisor (*):
4. Email of program advisor (*):
5. Name of program advisor:
6. Title of program advisor:
7. Phone number of program advisor:
8. Email of program advisor:

1. Participating school is enrolled in Fuel Up to Play 60. Enrollment is free and any US school can enroll online at fueluptoplay.com.
2. Are you enrolled : Yes No
3. If you selected no, please list reason (enrollment required to receive grant funds):
4. Student team involvement must be incorporated in the development of the school’s selected nutrition and physical activity action strategies.
5. a. How many Student team members are involved in FUTP 60?
6. b. Has the student team linked with the kit owner? Yes No
7. If you selected no, please list reason:
8. Are kit materials distributed throughout the school? Yes No
9. If not, what is the plan to display throughout the school?
10. Complete the online Fuel Up to Play 60 School Wellness Investigation to gather school wellness data to develop school's plan, available at www.FuelUptoPlay60.com; click on Getting Started.

1. Healthy Eating Action Strategies (Required, at least one must be selected, must include one way to increase access to and consumption of low fat and fat free dairy, in addition to all the Food Groups to Encourage.)
2. Healthy Eating Action Strategy 1:
3. Healthy Eating Action Strategy 2:
4. Healthy Eating Action Strategy 3:
5. Physical Activity Action Strategies (Required, at least one must be selected, must include increased opportunities for 60 minutes of physical activity every day for the entire school, before, during and after school)
6. Physical Activity Action Strategy 1:
7. Physical Activity Action Strategy 2:
8. Physical Activity Action Strategy 3:

1. Student team must include some type of “kick off” announcing the Fuel Up to Play 60 kit programs and incorporating FuelUptoPlay60.com participation to the entire student body
2. Please describe your kick off activity plan events

WDA will be providing up to (5) $1000.00 grants to launch Fuel Up to Play 60.
Goal is for the action strategies to be in place for the entire school year. Grants will be awarded January 2010.

Grant winning schools-Plan to complete the Keeping It Going Grant by April 1st for an additional $500.00. See Keeping it Going Grant application available in January 2010.

Note-Once your Healthy Eating and Physical Activity Action Strategies have been in place for at least four weeks, plan to do a quick evaluation to make sure your results are on track. That way you’ll know you’re implementing the most effective program possible for the remainder of the school year.

Submit your grant application by December 15, 2009. Up to Five school winners will be selected and will be notified by Dec. 16th.

Questions-call Tami Anderson at 720-356-3166

© 2009 NFL Properties LLC. Team names/logos/indicia are trademarks of the teams indicated. All other NFL-related trademarks are trademarks of the National Football League. © 2009 National Dairy Council®. Fuel Up is a service mark of the National Dairy Council. No purchase necessary. Void where prohibited by law. Contest open to any K-12 school accredited in WY. Up to 5 school winners will be selected and will be notified by Dec. 16, 2009.