Funds for Fuel Up to Play 60 20132014 Application Form Deadline: November 1, 2013 Link to application: http://school.fueluptoplay60.com/documents/Funds/Fuel_Up_to_Play_60_Funds_ Application_2013_2014.

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Part I School District: Miami-Dade County Public School District District Enrollment: 345,000 School: Ruth K. Broad Bay Harbor K-8 Center School Enrollment: 1,295 Grade Level: K-8 Address:
1155 93 STREET BAY HARBOR ISLANDS, FL 33154 City/State/Zip: BAY HARBOR ISLANDS, FL 33154 Phone: (305) 865-7912 Fax: (305) 864-1396

School Federal Employer Identification Number

Part 2 1. Please indicate the amount of funding your school is applying for (maximum of $4,000 for theschool year): $4,000 If your funding request is awarded: 2. Who should the check be made out to? Ruth K. Broad Bay Harbor K-8 Center Principal 3. To whose attention should the check be sent? Dr. Maria K. Rodriguez 4. Where should the check be mailed?
1155 93 STREET BAY HARBOR ISLANDS, FL 33154

5. Which years has your school been enrolled in Fuel Up to Play 60?
X 20122013 school year 20112012 school year 20102011 school year 20092010 school year

6. Does your school participate in the National School Lunch Program?

X Yes No

7. Does your school participate in the School Breakfast Program?

X Yes No

8. What percent of students at your school is eligible to receive free/reduced priced school lunch?
0% 19% 1019% 2029% 3039% X 4049% 5059% 6069% 7079% 8089% 9099% 100%

9. Is your local school wellness committee involved in planning and implementing Fuel Up to Play 60 at your school?
Yes No, the school wellness committee is not involved in the planning and implementing of Fuel Up to Play 60 at my school X No, we do not have a local school wellness committee or school health council

9a. If yes, please describe how the school wellness committee is involved: N/A 10. Fuel Up to Play 60 encourages all applicants to consider taking part in Lets Move! Active Schools and services and programs it offers. Is your school signed up to become a Lets Move! Active Schools? X Yes No Not Sure

Part 4
Healthy Eating Plan Replace processed foods with fresh choices e.g. not fruit-flavored items, real fruits Add at least 2 seasonal fruits and veggies with each meal Replace soda or high calorie/high sugar fruit drinks with water or low fat milk Follow choose my plate.govs guidelines, which are listed below:

11. Below is the Healthy Eating Play you identified that you will be implementing at your school this year.
Breakfast Grab and Go! Breakfast in the Classroom Make Your Case for School Breakfast X Build a Better Breakfast Promoting Popular Choices

12. How will your Healthy Eating Plan promote foods from all of the food groups? Lowfat/Nonfat Dairy: offer low-fat milk, cheeses Fruits and Vegetables: offer at least 2 fresh options with each meal Whole Grains: offer whole grain rice, pasta, breads 13. In what month during the 201314 school year do you anticipate beginning your Healthy Eating Play?
September October November December January X February March April May

 June July August

14. Over what length of time do you anticipate your Healthy Eating Play will be active at your school?
Less than one month 12 months 36 months Most of the school year X Ongoing activity (continuing into the next school year)

15. How will funding be used to help accomplish your Healthy Eating Play? -Membership to Redland Organics ($360 annually) to purchase bulk produce from local co-op farmers. -Purchase in-season produce $640 -Purchase healthy snack and drink options for Monthly Ceremonies $1000 16. What changes do you hope to see at your school this year as a result of implementing your Healthy Eating Play? Less processed foods at school meals, healthier students, no sodas or sugary drinks Students making healthier food selections outside of school 17. How will the changes outlined above continue beyond this school year, after funding is exhausted? Making healthy unprocessed foods available to the students will mean that in the future, they will continue to ask for those types of foods, outside of school as well. Teaching them as early as possible about portion sizes and healthy foods will hopefully give them the tools they need to make better food choices in the future.

5. Physical Activity Plan

We are NOT applying for funding for Physical Activity. N/A 18. Below is the Physical Activity Play you identified that you will be implementing at your school this year.
Dance Around the World All the Right Moves Walk for Wellness Club InClass Physical Activity Breaks X Special Opportunity Make Your Case for Quality Physical Education

Part 5 19. In what month during the 201314 school year do you anticipate beginning your Physical Activity Plan?
September October November December January February X March April May June July August

20. Over what length of time do you anticipate your Physical Activity Play will be active at your school?
Less than one month 12 months 36 months Most of the school year X Ongoing activity (continuing into the next school year)

21. How will funding be used to help accomplish your Physical Activity Play? I would like to purchase Polar heart rate monitors, Timex pedometers and replacement batteries. See table for cost breakdown.

Item Polar heart rate monitors CR240 replacement batteries Timex T5E011 pedometers

Cost $42.50 $7.95 $7.50

Quantity 30 40 50 Grand Total:

Total Price $1,275.00 $318.00 $375.00 $1,968.00

22. What changes do you hope to see at your school this year as a result of implementing your Physical Activity Play? Having these devices would provide children the opportunity to see first-hand how physical activity impacts their health. Heart rate monitors will not only teach them about the human heart and how it functions, but would also help illustrate how different levels of activity effect the body and our health, over time. These devices would also benefit other classes; math and science classes could utilize the pedometer and HR monitor data to calculate equations and to determine optimal heart rate zones. 23. How will the changes outlined above continue beyond this school year, after this funding is exhausted? The items purchased have a long life, and, if cleaned and cared for correctly, could be a part of the physical education department for many years to come. As mentioned above, the data collected from these devices can be utilized by teachers of other subjects as well, to create lessons related to caloric expenditure, heart rate zones, anatomy and biomechanics. X--We are NOT applying for funding for Kickoff and Promotional Activity. If you check this box, please skip this section and continue on to the Project Budget section.

Thes6. Kickoff and Promotional Activity Plan 7. Project Budget

Outline your budget in the worksheet below.

7. Project Budget
Items/Equip & Estimated Cost Redland Organics- $360.00, Bulk produce purchase-$640.00, Healthy snack & drinks-$1,000 Heart rate monitors, pedometers, batteries N/A Volunteers $3,960.00 Total Funding Already Approved for 2013/14 None

$2,000

Healthy Eating Plan

$1,960.00 N/A No Cost $3,960.00

None N/A None None

Physical Activity Plan Kick-Off And Promotion Plan Staff Stipends Total Funding Request

Overall Fuel Up to Play 60 Plan

28. What percent of the students at your school will participate in any way in Fuel Up to Play 60 inthe 201314 school year? Participating includes: helping to plan/implement activities, visiting website, tracking, participating in Kickoff Event, participating in Healthy Eating/Physical Activity Plays, etc. 0%

 119% X 2039% 4059% 6079% 8099% 100% 29. Describe how students will take an ACTIVE LEADERSHIP ROLE in planning and implementing the Healthy Eating, Physical Activity and/or Kickoff and Promotional Plans you outlined above. Class lessons will center around portion control, healthy eating and caloric intake. Students will be able to provide suggestions and preferences for what types of snacks and produce that is offered in the lunchroom. 30. Describe how you will track the impact of the Healthy Eating, Physical Activity and/or Kickoff and Promotion Plans you outlined above. We will track students progress through fitness and nutrition journaling. We will also survey the students and staff prior to the implementation, at the 6 month mark and at the 12 month mark to determine the progress of their knowledge and activity levels. Principals Name: Dr. Maria K. Gonzalez Principals Email: maria.k.gonzalez@dadeschools.net
X Your Principal approves this application and will fully support the proposed program and requirements, if funded.

School Nutrition Professionals Name: N/A School Nutrition Professionals Email Address: N/A
N/A Your School Nutrition Professional approves this application and will fully support the proposed program and requirements, if funded.

Physical Education Lead Teachers Name: Mr. Michael Arroyo Physical Education Lead Teachers Email Address: Michael.r.arroyo@dadeschools.net
X Your Physical Education Lead Teacher approves this application and will fully support the proposed program and requirements, if funded.

Program Advisors Name: Peggy Mandel Program Advisors Email Address: peggy.k.mandel@dadeschools.net
X Your Program Advisor approves this application and will fully support the proposed program and requirements, if funded.

31. Fuel Up to Play 60 Program Advisors registered at your school include: Place a check mark here if you will serve as the Fuel Up to Play 60 Program Advisor at your school.

32. Will you be involved in the planning and implementation of Fuel Up to Play 60 in your school? X Yes No If yes, how will you be involved? Parent volunteer 33. Please tell us if there are any other key adults, besides yourself, who will be involved in the planning and implementation of Fuel Up to Play 60 in your school. Name: Emma Jackson Job Title: Health & Wellness Committee Chair, PTA How will this individual be involved? Working in conjunction with PE teacher 34. Optional: Please share anything else Fuel Up to Play 60 should consider in reviewing your application. Currently, the school offers very few healthy food options for lunches and snacks. The food options in the predominantly Latin-American community arent available in small portions and dont always provide many vegetables. Teaching the students to eat what they love in smaller portions, and by adding more fresh produce and fewer sugars and empty calories would be beneficial. Monthly Student of the Month Ceremonies at the school offer breakfast to parents and students. The breakfast consists of tray after tray of sugary fried pastries. The only drink provided is apple juice. This unhealthy spread is sometimes the only breakfast option for the child. Although the pastries are tasty, this is unacceptable, and directly contributes to the growing childhood obesity problem both at the school and within the state. Using the funding, we could provide healthier ceremony food choices, by adding fresh produce and proteins and removing the empty calorie sugar-laden options from the table.