KINGSPORT CITY SCHOOLS

COORDINATED SCHOOL HEALTH

REQUEST FOR FUNDING APPLICATION

Name of Applicant _________________________________________ Date of Application___________________________

Title of Project _______________________________________________________ School__________________________________

Grade/Department_____________________________________________ School Health Index completed?___________

Approved: ___________________________________________________________________
Principal/Supervisor’s Signature/Date

Kingsport City Schools Coordinated School Health is offering the opportunity for KCS teachers to receive
funds for health-related programs and initiatives in our schools & classrooms. Typical awards will range
from $100-$1,000, although exceptions may be made for projects with the potential of significant impact.

In order to be considered for funding, proposals should address one of the following areas:

1. Physical Education/Physical Activity 5. Counseling/Mental Health

2. Nutrition Education 6. Family Engagement
3. Comprehensive Health Education 7. Healthy School Environment
4. School Health Index – Low Scores 8. Professional Learning

TIMELINE
Funding applications are due by September 10th, and will only be considered for funding upon the
completion of the School Health Index. Completed applications should be submitted to Misty
Keller at the Administrative Support Center (through school mail). All School Health Index results
and subsequent funding applications will be reviewed, and awards will be made by September
28th.

Please include the following in your application for funding:

I. Description/Objectives of the Project
a. Provide a summary of the project.
b. State the goals & objectives of your project and describe how they align with
state standards &/or address deficiencies on the School Health Index.
c. Identify which and how many students will be targeted.

II. Results/Evaluation
a. Explain how the use of these funds will impact student learning.
b. Identify how you will demonstrate success and/or evaluate the use of your
materials.

III. Budget
a. Identify the specific materials and costs for your project.
b. If the project exceeds the amount of the award, how will remaining funds be
secured?
c. Identify the location your materials can be obtained. (Attach website pages,
catalogue pages, etc). PLEASE CHECK AT LEAST THREE SOURCES TO FIND THE
BEST PRICE! Please include only the best price.
I. DESCRIPTION/OBJECTIVES OF THE PROJECT

II. RESULTS/EVALUATION

III. BUDGET
PLEASE INCLUDE PRICES OF EACH INDIVIDUAL ITEM AS WELL AS OVERALL TOTAL COST.