Grant Application Full legal name of organization Washington Irving Middle School Tax exempt status: Yes- nonprofit

organization Year organization was founded This would be the first year our organization will be funded with a projected start date of 1/1/2012 Date of application 12/5/2011 Address 8100 Old Keene Mill Road City Springfield State Virginia Zip 22512 Telephone number (703)912-4554 Fax number 703-912-4597 Web site address http://fcps.edu/IrvingMS/ Executive Director First name Danny Last name Little Primary Contact First name Stephany Last name Uriona Title 8th Grade Health & PE Teacher E-mail sruriona@fcps.edu Office Phone 703-912-4554 Office Fax 703-912-4597 Funding Request Afterschool Fitness and Physical Activity Program Note: Please use N/A if a question is not applicable to your organization.

Grant would cover period beginning: 1/01/2012 or when funding is received Grant would cover period ending: 06/19/2012 and would start up again in 09/2012-06/2013 Type of request Grant Amount of Funding Requested (in dollars) $4650.71 Please see attached for funding request details Project title (if project funding is requested) Fit is Fun Total project budget (if request is for other than general support) None Total organizational budget (current year) N/A Starting date of fiscal year 01/02/2012 Summarize the organization's mission (2-3 sentences) Our mission is to provide students with a variety of lifetime oriented fitness activities and promote health in a positive and enjoyable way. Our focus is to increase student physical activity time and provide the necessary for them to continue to make healthy lifestyle choices. Summary of project or grant request (2-3 sentences) With the assistance of CareFirst Grants, we hope to acquire equipment and supplies required for providing students with opportunities to participate in a variety of physical activities ranging from obstacle courses to yoga. Equipment will be kept at the school to be used by students of Irving Middle School, as well as by the children in the community who use the schools Teen Center. How did you learn about the CareFirst Commitment grant process? AT GRANTS FOR TEACHERS www.grants4teachers.com NARRATIVE - ORGANIZATION A. Introduction and Background of Organization (2-3 pages) Briefly describe your organization's history, mission and goals Washington Irving Middle School is a school that provides diverse opportunities. Our afterschool program offers clubs, training sessions with high school coaches and intramural sport

leagues are currently in the process of be approved. None of these programs, however, focus on lifetime oriented fitness activities. Our mission is to provide students, who have limited financial opportunities, the chance to experience diverse fitness activities in a fun way. We will incorporate team challenges, solo competitions, and activities to boost ones self confidence. By allowing students to experience activities other than organized team sports, we hope to serve as a foundation for students to begin making choices that enhance their personal health and fitness. Describe your current programs and activities Our current program includes clubs such as Track Club and Girls on the Run. Also, our student activities director has worked with local high schools on having coaches and athletes come in and prepare our students for upcoming sports seasons. We also work with the Teen Center to provide activities to our students during our evening hours. The Teen Center offers open gym and organized play opportunities for students. Who is your constituency (be specific about demographics such as race, class, gender, ethnicity, age and people with disabilities)? How they are actively involved in your work and how do they benefit from this program and/or organization? Our program will only be offered to students of Washington Irving Middle School. We are located in Springfield, Virginia; a suburban, middle class community. Students in this area a predominantly Caucasian but include minorities of Southeast Asian, Hispanic, African American, and Middle Eastern descent. Our middle school educates 7th and 8th grade students who are between the ages of 11 to 15 years old. Initially, we will have teachers and staff running the program and facilitating activities, but over time, we

intend on creating a student run fitness committee that will take over our responsibilities of choosing and running their own programs. We hope to encourage students to increase their level of fitness and find joy in physical activity. We hope to provide activity opportunities that afford students opportunities to build confidence in themselves and their abilities, Regardless of their initial level of fitness. To achieve this goal, we will design each activity in a way that teaches students how to make extensions and refinements in their exercises to increase or decrease difficulty. We will address our topics and concerns from daily health lesson and this will serve to extend our material from class. Please summarize how your proposal fits with CareFirst's mission and grant making interests. Our program is just a tiny stepping stone to reaching our overall goal of increasing peoples personal health and wellness. We hope to teach our students lifelong fitness activities which have been shown to provide preventative protective qualities against many illnesses and diseases. A significant portion of Irvings students suffer from conditions such as asthma, diabetes, and being overweight and we hope to help these students learn not only how to manage their conditions but combat it with lifestyle changes. We will offer physical activity time and include pamphlets, brochures, and newsletters on exercises that can be done at home with little or no equipment. To reinforce our health units, we will address topics such as proper nutrition, emotional and social behaviors, and dangerous affects of drug use. We will encourage our students to motivate their families to

participate in their exercises and nutrition changes with them and hopefully this will affect our community as a whole.

NARRATIVE - REQUEST B. Describe Your Request (2-3 pages) State the issue or need to be addressed, describe the size and/or severity of the issue or need, and explain the evidence regarding this issue or need. If applicable, provide demographic and geographic information regarding the community or population benefiting from or served by the request. Being located in a concentrated suburban area, our students have limited availability to free physical activity programs that provide transportation. Our target groups are 11 to 15 year adolescents and have limited influence on families time and how financial resources are spent. With more than half of our students on free or reduced lunch, this program focuses on providing students with opportunities to engage in physical activity at no cost to them and their families. Irving has seen a disappointing increase in the number of students who are overweight and progressing to obese and we worry that without proper intervention, the chances of our students suffering from diseases and chronic conditions will be greater. Our student health services office has provided our school, which has roughly 1000 students, with a Medical Flag List of more than 500 students names who are on some sort of medication or have a health condition that would require our attention during physical activity.

Most of our students are aware of their conditions but dont know how to manage their illnesses with proper activity. Describe the program or project. For new programs, describe how the program model was developed. For ongoing programs, describe the program's track record. Program was developed from physical activity classes offered at local fitness facilities. Our program structure and activities were created with faculty members of Irving Middle School along with reviewed by faculty at George Mason University. Initially our program will run once a week, varying THE day offered afterschool every week so that students who have prearranged activities can coordinate to attend sessions as they find time. More sessions will be offered per week once our program is up and running. We will allow a maximum of 30 per session due to our limitations with equipment and space. Fit is Fun will offer activities such as boot camp, Frisbee golf, Zumba, Pilates/Yoga, Insanity, Weight room opportunities, obstacle courses, and more. The duration of each session will be 60 minute with a 5 minute water break in-between. Session titles will be posted on a calendar outside the gymnasium and students are to sign up to reserve their spot for the class. Students will also be able to access program, provide ideas, and sign up through a group account made through Facebook.com. Program instructors will have a range of personal expertise with different activities and will facilitate each session. Discuss the anticipated results (outputs and/or outcomes) for the request. Explain how the activities directly and/or indirectly address the issue or need and support the achievement of these results

We anticipate more than 200 students participating IN this program. Once Fit is Fun is up and running, we will add multiple days during the week to participate in our fitness sessions. Since our goal is to provide students with physical activity opportunities with the hope that they will enjoy being active. We intend on increasing the number of sessions offered in accordance with the number of student attending as a way to ensure all students in the program will be afforded significant amounts of activity time. Not only that, but our goal is to have students enjoy participating in fitness and therefore continue having exercise in their lives. For general support requests, describe how the request will enhance organizational capacity, sustainability, and/or the achievement of measurable results for the organization. With Carefirsts financial assistance, we will be able to provide the students opportunities to use equipment and materials that are usually not accessible to them. Equipment ordered will be stored at Irving so that it can be used each school year and run with assistance of other teachers and members of the PTA. If not specifically listed above, please indicate the number of people served by this grant request. Program will be offered to students of Irving middle school. Current enrollment is roughly 1000. How does your work reduce health disparities, improve quality of care, meet the needs of the uninsured, promote healthy lifestyles or address chronic diseases? Our program is focused on increasing students physical activity levels and fitness development as a way to improve students overall health. Our primary concerns are addressing overweight/obesity and helping to prevent

chronic diseases through participation in lifetime oriented fitness development activities. Our program will be offered to all students regardless of financial income and will be marketed specifically to students known by the school staff to have limited physical activity opportunities. We will encourage students to participate in lifetime fitness development activities and help them create goals that will be managed through our schools website. Another way we plan to promote healthy lifestyles is through pamphlets, brochures, and a Facebook account that will include nutrition information, health guidelines and recommendations, and exercise tips and photos. Indicate what outcome and/or impact information will be collected to measure and demonstrate success. We are currently just focused on getting students to show up and attempt the activities being offered. Student numbers and gender, specifically gender preferences for different sessions, will be recorded. We will offer more sessions with the most number of students most often and encourage students to bring friends as well. We hope that our program will be considered cool and fun and students will enjoy exercise. For general operating support requests, please describe how your organization assesses its overall success and effectiveness. Multiple people will be allowed to provide input and their suggestions will be taken into consideration. Our principal, also an experienced PE teacher, along with our schools student activities coordinator, Dr. Lindsay, will oversee and approve all activities prior to our presentation of them. In

addition, a faculty member at a local research university will periodically consult on activities and teaching approaches. Our hope is to start a blackboard site as well with videos of activities and fitness trackers for students to monitor their activity time. The larger our numbers become, will guide our knowledge of our programs success. If applicable, provide a timeline for implementing the request. Once funding is received, program will begin immediately upon arrival of the equipment and materials. 12/15/2011- Organizers will meet and review equipment available, dates instructors can stay after, and activities list will be created. 12/21/2011- Preliminary calendar must be submitted to Mr. Danny Little for review of activities. Once approved, Facebook page, posters, and student advertisement will be made and posted around the school. 12/29/2011- Lesson Plans for all activities must be approved by Mr. Little and Dr. Lindsey. 1/3/2012- First afterschool session. 1/11/2012- second afterschool session 1/19/2012- third afterschool session 1/23/2012- fourth afterschool session 1/25/2012- Program instructors will meet again. Review of program numbers and suggestions from Facebook will be considered. February calendar and lessons will be made and submitted for approval. To continue, after every fourth session, program members will meet. Organizational Capacity Describe the organization's ability to implement the request or explain the organizational limitations that funding will address. The equipment we are requesting is expensive and difficult to obtain in present economic conditions. Although our school has the necessary space and we are accessible to students on multiple days, our budget does not allow for us to make purchases that big. Most schools do not offer outdoor adventure units or weight training programs that are similar to what

students will be offered outside of school. With the funding provided, we want students to experience use of materials that local fitness centers offer. Explain how this proposal relates to your organization's mission, goals and or strategic objectives and other activities planned for this year. This proposal will serve as our means of acquiring the necessary equipment and materials to provide students with the opportunities to attempt a variety of lifelong fitness activities. We will use the grant money to obtain equipment to keep at the school but also teach students how to use similar items from their homes to continue their workouts without the need of store bought equipment. Describe how the request will enable your organization to build its capacity, address current limitations, or improve its ability to meet program or organizational goals. Our program will enhance Irvings already existing health and physical education program and will take to increasing health awareness after school hours. Initially, our program is targeting our youth but once students begin to become motivated and involved, we intend on extending outside of Irvings students and more into their homes. We will provide health fairs with specialists who can come in and give trainings on nutrition, safety, and preventative measures for diseases. Fair will include nurses who can give free vision, hearing, and blood exams for families with no health insurance. Describe the organization's current programs and activities, track record, related program or organizational accomplishments,

accreditation, awards, or other strengths that enhance capacity or sustainability. Currently, no programs have been created with the purpose of expansion beyond students. Irving does maintain clubs such as track and girls on the run and is currently seeking to reinstate intramural sport leagues. Describe the organizational structure and board/staff responsibilities. List the names, qualifications, and number of years in their position for key staff and/or volunteers relevant to the current request. Stephany Uriona- will serve as director and PRIMARY teacher for this program. I have a Health and Physical education Bachelors degree from George Mason University and am currently in the process of receiving a Masters degree in the same field. I am a full time Health & Physical education teacher at Irving and have been there for 3 years. I have experience working with children of all ages as I have coached at the high school and elementary levels for over 3 years. I participate in a variety of activities myself which include Zumba, Latin Dance, Boot Camp courses, and team sports such as soccer, basketball, and volleyball. Previously, I worked for Neurology Center of Fairfax for over 5 years and have seen firsthand the importance of preventative measures for diseases. I will be responsible for creating activities, setting up equipment, and working with student activities director on expanding our program into summer programs and upcoming years. Similar to class lesson plans, our after school sessions will have similar plans made prior to students

attempting our sessions. Plans will be approved by Adam Brown, and/or Dr. Lindsey. Adam Brown- is a Health and PE teacher at Irving Middle School who has been teaching for over 5 years. Being an experienced coach and athlete himself, he will work with me to create activities for students. He will also run program on days that I am unavailable to do so. Mr. Danny Little- principal of Irving Middle school. Resource and consultant Dr. Lawrence Lindsey- student after school activities coordinator at Irving Middle School. Resource and consultant Dr. Matthew Ferry- Professor at George Mason University. Nine years of teaching and research experience with a M.S and PhD in kinesiology. Resource and consultant. Indicate links with other organizations doing similar work in your geographic area or on the same issue. Health and Physical Education Program at George Mason University Describe the organization's relationship with stakeholders such as community residents, clients, staff, board members and other constituents. Currently there are no relationships with stakeholders but program leaders will reach out to the Parent Teacher Association (PTA) to see if additional funding and support will be provided. George Mason Universitys Health and Physical Education program will also be solicited for help in funding and organization.

Indicate the organization affiliation with federated funds or public agencies. N/A Geographic Area Served The box below will calculate all of the percent numbers entered above. The number in this box should total to 1.0 (equals 100%) once you click on the update icon at the bottom of the page. Your percentage MUST equal 1 before you can submit your application for review. Fairfax County 100 % Note: Should this online application be considered, a member of the CareFirst Commitment team may contact you for additional information. Please attach the financial and organizational information requested in the next section. Grant decisions are rendered in approximately 4 - 8 weeks. Requests of $25,000 or higher may take up to 12 weeks to review for funding consideration. ATTACHMENTS To fully consider your application we ask that you attach the following information: 1. A copy of the organizations current IRS determination letter (or the fiscal agents) indicating 501(c)(3) tax-exempt status. Attached 2. Organizational Budget for current fiscal year. 3. Program Budget 4. Most recent Financial Statement(s). none applicable 5. IRS 990 form 6. Board of Director 7. Optional attachments may include: letters of support, annual report, or recent newspaper/magazine articles. Please use discretion in limiting additional attachments. Upload The maximum size for all attachments combined is 100 MB. Please note that files with certain extensions (such as .exe, .com, .vbs, .bat) cannot be uploaded.