Challenge Day Student Survey Instructions

Size: px
Start display at page:

Download "Challenge Day Student Survey Instructions"

Transcription

1 Challenge Day Student Survey Instructions Notify Parents of Intentions to Administer Survey Send a letter home to the parents/guardians of students who have been selected to participate in the Challenge Day Program informing them that their students will also be participating in an attitude survey. Allow parents to opt out if they do not want their student(s) to participate. (A sample letter is included in this packet.) Administer Student Survey As soon as possible after each Challenge Day Event (not on the day of the event), have the students who attended Challenge Day complete the online survey by going to the following link: Click on the link that reads: Challenge Day Survey, Single User Enter the password: bethechange (no spaces) If You Want to Use Paper Surveys If you want to offer the students the option to complete the survey on paper, we have provided a copy of the survey with these instructions for your convenience. In order to be included in our survey process, the surveys will need to be entered into our online survey system. Follow the same link: Click on the link that reads: Challenge Day Survey, Multiple Entry Enter the password: bethechangenow (no spaces)

2 (Copy and paste this page into a new document and edit as appropriate for your school.) Sample Parent/Guardian Letter Dear Parent or Guardian, As part of the Challenge Day Program, your child has been selected to participate in an anonymous student attitude survey. The survey is designed to measure student attitudes about issues such as school safety, self-esteem, and peer-to-peer relationships. The survey will be administered to the students on date:. Student responses to the survey will be anonymous (we will not be tracking how each student responds to the questions on the survey). If you do NOT want your student to participate in the survey, please sign and return the bottom portion of this form. I do NOT give my permission for my child/ward to participate in the student attitude survey. I understand that the survey is not required and that my child s/ward s participation is voluntary. Student s Name (please print) Parent/Guardian Name (please print) Parent/Guardian Signature Phone Number Page 2

3 2017/2018 Challenge Day Student Survey Background Information * 1. Select School From List * 2. Date of Program Date MM / DD / YYYY 3. Was this your first Challenge Day? Y N If not, how many have you attended? * 4. What grade are you in? * 5. What is your gender? * 6. What is your race/ethnicity? Other (please specify) 1

4 2017/2018 Challenge Day Student Survey Survey Questions * 7. Select an answer from the drop down menu on the left that best represents how true the statement was about you before you attended Challenge Day, then select an answer from the right that best represents how true the statement is for you after your Challenge Day experience. Before Challenge Day After Challenge Day I feel connected to the students and adults at my school. I believe no one at my school understands my feelings or experiences. I feel I can be myself and freely express myself at school. I actively contribute to making my school feel safe and inviting for everyone. I have tools to help me be aware off my feelings. There are adults and students at my school that I can talk to about my feelings and experiences. I am aware of what life is like for my schoolmates. I feel compassion and empathy for my schoolmates. I believe talking openly about my life is a helpful way to relieve stress. My school is a supportive learning environment. I have strategies to help me control my emotions and behaviors. 2

5 Before Challenge Day After Challenge Day I feel supported in making responsible decisions. I know that unexpressed emotions can lead to violence and self-harm. I feel empowered to influence change at my school, in my community and/or in the world. I have supportive and positive connections with friends, teachers and family. I understand the impact of my actions on others. I believe that I am not alone. I understand why people bully others. I trust the adults and students at my school. I feel confident in my ability to set and reach my goals. I am respected by, and offer respect to, everyone in my school community. I ask for help when I am having a hard time emotionally, academically or socially. I am accepting of people who are different from me. Please indicate how much you agree with the statements below. 3

6 * 8. It is important for teachers, administrators, counselors and parents to participate in Challenge Day. Strongly * 9. Learning can be hard for me when I feel stressed, worried, or scared. Strongly * 10. I would like to learn more about how to notice, manage and safely express my feelings. Strongly * 11. I will use what I learned at Challenge Day in my daily life. Strongly * 12. I would recommend Challenge Day to friends and family. Strongly 4

Young Women Leaders Program! Application Packet for

Young Women Leaders Program! Application Packet for Young Women Leaders Program! Application Packet for 2016-2017 Dear Young Leaders and Families, From all of the staff at Ohio University s Women s Center, I want to thank you for considering applying to

More information

MENTAL HEALTH AND EMOTIONAL WELLBEING KEY STAGES 3 AND 4

MENTAL HEALTH AND EMOTIONAL WELLBEING KEY STAGES 3 AND 4 MENTAL HEALTH AND EMOTIONAL WELLBEING KEY STAGES 3 AND 4 PROGRESSION Strands KS3 Questions 1 Content 1 KS3 Questions 2 Content 2 KS4 Questions 3 Content 3 Understanding and expressing emotions How do I

More information

We are inviting you to participate in a research study/project that has two components.

We are inviting you to participate in a research study/project that has two components. Dear TEACCH Client: One of the missions of the TEACCH Autism Program is to support research on the treatment and cause of autism and related disorders. Therefore, we are enclosing information on research

More information

mehealth for ADHD Parent Manual

mehealth for ADHD Parent Manual mehealth for ADHD adhd.mehealthom.com mehealth for ADHD Parent Manual al Version 1.0 Revised 11/05/2008 mehealth for ADHD is a team-oriented approach where parents and teachers assist healthcare providers

More information

Summer Youth Institute Packet

Summer Youth Institute Packet Dear Prospective Youth Volunteer, Summer Youth Institute Packet Thank you for your interest in the Volunteers of America s Youth Volunteer Summer Institute! Volunteers of America is a national, non-profit,

More information

Bikes Not Bombs. Youth s Name : First Middle Last Address: Number Street Apartment. City State Zip Cell Phone. Name of School: Grade:

Bikes Not Bombs. Youth s Name : First Middle Last Address: Number Street Apartment. City State Zip Cell Phone. Name of School: Grade: Bikes Not Bombs Summer 2018 Session #2 Earn-A-Bike July 30th Aug 16th (Mon-Fri, 2:00-6:00) Ages 12-18 ~Program fee $25-50 ( Fee Waivers available! See Program Fee section for more info. ) There are a limited

More information

We are inviting you to participate in a research study/project that has two components.

We are inviting you to participate in a research study/project that has two components. Dear TEACCH Client: One of the missions of the TEACCH Autism Program is to support research on the treatment and cause of autism and related disorders. Therefore, we are enclosing information on research

More information

2016/2017 School Year - National Help America Hear Scholarship

2016/2017 School Year - National Help America Hear Scholarship 2016/2017 School Year - National Help America Hear Scholarship The scholarship is open nationally to high school seniors who have a hearing loss, which requires the use of hearing aid(s) in their daily

More information

NAMI Ending the Silence Education Program Teacher Application. Name Date. Home Address. City State Zip Code. Sponsoring NAMI Affiliate.

NAMI Ending the Silence Education Program Teacher Application. Name Date. Home Address. City State Zip Code. Sponsoring NAMI Affiliate. NAMI Ending the Silence Education Program Teacher Application Name Date Home Address City State Zip Code County Sponsoring NAMI Affiliate Phone ( ) Cell ( ) Email _ Special Dietary Needs (vegetarian, allergy,

More information

Dear Prospective Cotillion Participant:

Dear Prospective Cotillion Participant: Dear Prospective Cotillion Participant: The time is here for the premier event in DeKalb County: The Forever Pink Foundation, Inc. Debutante Cotillion! The Forever Pink Foundation, Inc. would like to thank

More information

Dear Student, August 2017

Dear Student, August 2017 High School Application Dear Student, August 2017 We would like to invite you to apply to be on our ACTS Leadership Development team. Over the past few years we have worked hard to make this program something

More information

NAMI Family-to-Family Education Program Teacher Application. Name Date. Home Address. City State Zip Code. Sponsoring NAMI Affiliate.

NAMI Family-to-Family Education Program Teacher Application. Name Date. Home Address. City State Zip Code. Sponsoring NAMI Affiliate. NAMI Family-to-Family Education Program Teacher Application Name Date Home Address City State Zip Code County Sponsoring NAMI Affiliate Phone Cell Email Special Dietary Needs (vegetarian, allergy, kosher,

More information

Mental Health. Integration. School Baseline Evaluation Packet. The school has my permission to return forms directly to the clinic.

Mental Health. Integration. School Baseline Evaluation Packet. The school has my permission to return forms directly to the clinic. Mental Health Integration School Baseline Evaluation Packet To be filled out by physician/office staff Today s Date: Student s Name: Physician Name: Clinic Name: Clinic Address: Student s Phone: Clinic

More information

2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS

2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS 1 http://hearingloss-nj.org/ 2009 ANNUAL SCHOLARSHIP AWARD FOR HIGH SCHOOL SENIORS WITH A HEARING LOSS The is pleased to announce a scholarship for high school seniors with a hearing loss, who are pursuing

More information

1 week before the first meeting Date:

1 week before the first meeting Date: Version 6.1 BBA Workshop & 12 Step Sponsorship Guide Page 1 of 10 Getting Started. You will need the following: Big Book of Alcoholics Anonymous Large Print or hard back book Big Book Awakening Workbook

More information

Threat Assessment in Schools (2002). Washington, D.C.: U.S. Secret Service & U.S. Dept. of Education.

Threat Assessment in Schools (2002). Washington, D.C.: U.S. Secret Service & U.S. Dept. of Education. Six Principles of the Threat Assessment Process Threat assessment is a central component in preventing targeted school violence. The threat assessment process involves identifying, assessing, and managing

More information

Through the use of the stress management programs offered, the department projects the following benefits:

Through the use of the stress management programs offered, the department projects the following benefits: Kent PD Title #8.90 Peer Support Policy There is a need for employees to have support for both personal and professional crisis situations and general work stressors. Employees may be under personal stressors,

More information

2. Display K-Kids posters, available from the Kiwanis International Office, around the school announcing the first meeting date and time.

2. Display K-Kids posters, available from the Kiwanis International Office, around the school announcing the first meeting date and time. K-Kids Member recruitment suggestions 1. Provide K-Kids brochures to students when they register for the school year. Distribute brochures to faculty and ask that they give information to students and

More information

Chapter 4. Lessons. Managing Mental and Emotional Health. Managing Mental and Emotional Health

Chapter 4. Lessons. Managing Mental and Emotional Health. Managing Mental and Emotional Health Managing Mental and Emotional Health Managing Mental and Emotional Health Lessons Lesson 1 Emotions Lesson 2 Understanding Emotions Lesson 3 Expressing Emotions Lesson 4 Coping with Emotions Lesson 5 Mental

More information

MONROVIA UNIFIED SCHOOL DISTRICT Administrative Regulation SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION

MONROVIA UNIFIED SCHOOL DISTRICT Administrative Regulation SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION Definitions SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION Comprehensive sexual health education means education regarding human development and sexuality, including education on pregnancy, contraception,

More information

UNIVERSITY HOSPITALS CASE MEDICAL CENTER CONSENT FOR INVESTIGATIONAL STUDIES (v )

UNIVERSITY HOSPITALS CASE MEDICAL CENTER CONSENT FOR INVESTIGATIONAL STUDIES (v ) UNIVERSITY HOSPITALS CASE MEDICAL CENTER CONSENT FOR INVESTIGATIONAL STUDIES (v. 11.2012) Project Title: The Impact of Achilles Tightness on Lower Etremity Injuries in Adolescent Athletes Principal Investigator:

More information

TAPED Teacher and Interpreter Scholarships

TAPED Teacher and Interpreter Scholarships Families, educators, and communities collaborating to ensure excellence, equality and success for students who are deaf or hard of hearing. TAPED Teacher and Interpreter Scholarships The Texas Association

More information

UNION MINE HIGH SCHOOL

UNION MINE HIGH SCHOOL UNION MINE HIGH SCHOOL Home of the DIAMONDBACKS umhs.eduhsd.k12.ca.us (select Athletics) Principal: Paul Neville Athletic Director: Jay Aliff FALL WINTER SPRING August 7, 2017 November 6, 2017 February

More information

Table of Contents. Title: Drugs Policy Page 2 of 7

Table of Contents. Title: Drugs Policy Page 2 of 7 Drugs Policy Table of Contents Statement of Intent... 3 1. Introduction... 3 2. Academy Ethos... 3 3. Drug Education... 4 3.1 Aims of drug education:... 4 3.2 Planned drug education... 4 3.3 Inviting outside

More information

For Students Who are Deaf or Hard of Hearing

For Students Who are Deaf or Hard of Hearing For Students Who are Deaf or Hard of Hearing June 3 - June 15, 2018 Driver Education for Students Who are Deaf or Hard of Hearing Two-week Long Summer School for Eligible Ohio Teens Columbus, OH The Ohio

More information

AMIAS Training Option #4: Course Summary of Key Points and Test

AMIAS Training Option #4: Course Summary of Key Points and Test AMIAS Training Option #4: Course Summary of Key Points and Test What do we want Verbalize / recognize that at least one certified AMIAS (group sponsor) must be present in every Alateen meeting. They will

More information

A NEW FUNDRAISING IDEA FOR YOUTH GROUPS INFORMATION PACKET

A NEW FUNDRAISING IDEA FOR YOUTH GROUPS INFORMATION PACKET A NEW FUNDRAISING IDEA FOR YOUTH GROUPS INFORMATION PACKET Serving others through sponsorship is an amazing way for young people here in the U.S. to expand their worldview and do good in the world, and

More information

Grade 6 Sexual Health Curriculum Overview

Grade 6 Sexual Health Curriculum Overview Grade 6 Sexual Health Curriculum Overview Rights, Respect, Responsibility The Advocates for Youth s Rights, Respect, Responsibility curriculum is based on the belief that: Youth have the right to honest

More information

Youth Recognition Awards

Youth Recognition Awards Wattle Range Council present its first Youth Recognition Awards My Community is your Community Find us on Facebook 1 INTRODUCTION Welcome the second Wattle Range Council Youth Recognition Awards. As part

More information

SDSS DRY GRAD COMMITTEE Delta, BC. Class of 2015

SDSS DRY GRAD COMMITTEE Delta, BC. Class of 2015 Class of 2015 January 28, 2015 To all Parents/Guardians of Grade 12 Students: Dry Grad is a drug and alcohol free supervised party which takes place immediately following the Grad Banquet and Dance on

More information

Hearing Loss Association of America, Inc., Rochester Chapter

Hearing Loss Association of America, Inc., Rochester Chapter Hearing Loss Association of America, Inc., Rochester Chapter 2019 SCHOLARSHIP APPLICATION FORM This scholarship is awarded by the Hearing Loss Association of America, Rochester Chapter in the amount of

More information

Suicide Prevention. Kuna High School

Suicide Prevention. Kuna High School Suicide Prevention Kuna High School Why Suicide Prevention is Important? From the 2015 Youth Risk Behavior Survey (CDC). Suicide 32% (up 4% from 29% - 2013) felt so sad or hopeless almost every day for

More information

Asthma Please complete packet and return to nurse at child s school

Asthma Please complete packet and return to nurse at child s school Health forms for students with Asthma Please complete packet and return to nurse at child s school What s in this packet? 1) Asthma Questionnaire to describe student s asthma 2) Release of Information

More information

Outcome Measurement Guidance

Outcome Measurement Guidance Outcome Measurement Guidance The following learning objectives, goal statements and accompanying outcome items were prepared by the Ohio Department of Health Rape Prevention Education Team to assist you

More information

About this consent form. Why is this research study being done? Partners HealthCare System Research Consent Form

About this consent form. Why is this research study being done? Partners HealthCare System Research Consent Form Protocol Title: Gene Sequence Variants in Fibroid Biology Principal Investigator: Cynthia C. Morton, Ph.D. Site Principal Investigator: Cynthia C. Morton, Ph.D. Description of About this consent form Please

More information

Dear Parent/Guardian:

Dear Parent/Guardian: Dear Parent/Guardian: The of Delta Sigma Theta Sorority, Incorporated, invites you and your teenager to join our 2016-2017 E.M.B.O.D.I (Empowering Males to Build Opportunities for Developing Independence)

More information

VERIBEST I.S.D. DETERRENT TO ILLEGAL DRUG AND ALCOHOL USE

VERIBEST I.S.D. DETERRENT TO ILLEGAL DRUG AND ALCOHOL USE VERIBEST I.S.D. DETERRENT TO ILLEGAL DRUG AND ALCOHOL USE 2018-2019 Approved by Veribest ISD Board of Trustees May 15, 2017 The purpose of the drug testing policy is: PURPOSE/OBJECTIVES 1. To prevent illegal

More information

Initial Clinical History and Physical Form

Initial Clinical History and Physical Form 601 E FM 544, Suite 400, Murphy, TX, 75094 TEL: 972-442-4700 Initial Clinical History and Physical Form Patient Information Name: Age: of Birth: / / Sex: Male / Female Marital Status: Single Married Divorced

More information

Content Area: Comprehensive Health Grade Level Expectations: Sixth Grade Standard: 2. Physical and Personal Wellness in Health

Content Area: Comprehensive Health Grade Level Expectations: Sixth Grade Standard: 2. Physical and Personal Wellness in Health Colorado Academic Standards Comprehensive Health - Sixth Grade Content Area: Comprehensive Health Grade Level Expectations: Sixth Grade Standard: 2. Physical and Personal Wellness in Health Prepared Graduates:

More information

POsitive mental health for young people. What you need to know about Children and Adolescent s Mental Health Services (CAMHS) in Buckinghamshire

POsitive mental health for young people. What you need to know about Children and Adolescent s Mental Health Services (CAMHS) in Buckinghamshire POsitive mental health for young people What you need to know about Children and Adolescent s Mental Health Services (CAMHS) in Buckinghamshire 1 CONTENTS PAGE 3 AND 4 When to ask for help PAGE 5 AND 6

More information

The emotional side of diabetes

The emotional side of diabetes The emotional side of diabetes Diabetes can take a lot of effort to manage. So it s not surprising that many people who have it feel overwhelmed. If you have felt that way, you re not alone. Read on to

More information

GRIEF GROUP REGISTRATION

GRIEF GROUP REGISTRATION GRIEF GROUP REGISTRATION Oklahoma City, Monday Night Grief Support Edmond Tuesday Night Grief Support Parent or Guardian MUST attend sessions with their children Name: (Check One) Mother Father Grandmother

More information

Welcome to the Community Children and Young People s Service. Information you will find useful during your contact with the service

Welcome to the Community Children and Young People s Service. Information you will find useful during your contact with the service Welcome to the Community Children and Young People s Service Information you will find useful during your contact with the service 1 Contents Page Support in a crisis 3 About the service 4 Appointments..

More information

APPLICATION FOR AL ANON MEMBER INVOLVED IN ALATEEN SERVICE (AMIAS)

APPLICATION FOR AL ANON MEMBER INVOLVED IN ALATEEN SERVICE (AMIAS) Al Anon Family Groups Florida South (Area 10), Inc. hereafter referred to as AFG Florida South APPLICATION FOR AL ANON MEMBER INVOLVED IN ALATEEN SERVICE (AMIAS) This information will only be used in accordance

More information

GISD Suicide Prevention Plan

GISD Suicide Prevention Plan GISD Suicide Prevention Plan 2017 2018 Purpose The purpose of this plan is to protect the health and well being of all district students by having procedures in place to prevent, assess the risk of, intervene

More information

Drakey s Team Ipad Scholarship Program

Drakey s Team Ipad Scholarship Program Drakey s Team Ipad Scholarship Program Drakey s Davis was able to get early intervention when he was diagnosed with Autism at 2 ½. His family got him an ipad and Proloquo2go to help with his speech, along

More information

PSF Pediatric RES: Helpline. then share the. reviewing all program. Program. materials may

PSF Pediatric RES: Helpline. then share the. reviewing all program. Program. materials may PSF Pediatric Office Impleme entation Procedures PSF PROGRAM IMPLEMENTATION PROCEDUR RES: Getting Started 1. Each office needs a PSF Contact (PSF-C); this person will be the main contact for anything related

More information

Orlando Alumnae Chapter of. Delta Sigma Theta Sorority, Inc.

Orlando Alumnae Chapter of. Delta Sigma Theta Sorority, Inc. of Delta Sigma Theta Sorority, Inc. Catching the Dreams of Tomorrow Preparing Young Women for the 21 st Century Greetings Potential Delta Academy Participant, You are invited to participate in an exciting

More information

Preparing for and Responding to a Death by Suicide

Preparing for and Responding to a Death by Suicide Preparing for and Responding to a Death by Suicide Orange County New york Responding to and Working with the Media Sample Forms for Schools Announcements for Students, Faculty, and Staff Notification Letter

More information

CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION AND EMERGENCY FORM

CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION AND EMERGENCY FORM CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION Child's Name Date of Birth Parent/Guardian's Full Name Address Street: Address Line 2: City, State, Zip: Phone ( ) - Email EMERGENCY CONTACT INFORMATION OTHER

More information

July, Dear Parents and Coaches:

July, Dear Parents and Coaches: July, 2007 Dear Parents and Coaches: Cary S. Keller, MD, FACSM and Sportsmedicine Fairbanks are pleased to provide the Fairbanks Community with Sportsmedicine and Orthopaedic quality care. The mission

More information

Improving Emotional Wellbeing for Young People. Mike Derry and Anna D Agostino - Healthwatch Richmond

Improving Emotional Wellbeing for Young People. Mike Derry and Anna D Agostino - Healthwatch Richmond Improving Emotional Wellbeing for Young People Mike Derry and Anna D Agostino - Healthwatch Richmond Aim To collect young people's experiences of: Emotional wellbeing and related services Recommend improvements

More information

INVENTORY OF POSITIVE PSYCHOLOGICAL ATTITUDES (IPPA-32R) Self-Test Version

INVENTORY OF POSITIVE PSYCHOLOGICAL ATTITUDES (IPPA-32R) Self-Test Version ==RESOURCES FOR RESILIENCE== BUILDING A RESILIENT WORLDVIEW INVENTORY OF POSITIVE PSYCHOLOGICAL ATTITUDES (IPPA-32R) Self-Test Version Jared D. Kass, Ph.D., LMHC, Director Lynn Kass, M.A., M.A.T., LMHC,

More information

William Howard Taft High School

William Howard Taft High School William Howard Taft High School Return To Learn / Return To Play Policy This protocol is intended to provide an outline of the procedures we follow during the course of the school day, as well as contests/matches/events,

More information

Appendix M Sudden Arrhythmia Death Syndrome (SADS)

Appendix M Sudden Arrhythmia Death Syndrome (SADS) Appendix M Sudden Arrhythmia Death Syndrome (SADS) Sudden Arrhythmia Death Syndrome (SADS) refers to a variety of cardiac disorders which are often genetic and undiagnosed that can be responsible for sudden

More information

DANCETHON A BALANCED DIET Theme The benefits of diet on self-esteem and physical performance. Taking personal responsibility for food choices.

DANCETHON A BALANCED DIET Theme The benefits of diet on self-esteem and physical performance. Taking personal responsibility for food choices. DANCETHON A BALANCED DIET Theme The benefits of diet on self-esteem and physical performance. Taking personal responsibility for food choices. Aim For children to realise that having a balanced diet can

More information

HIV/AIDS KNOWLEDGE SERIES NO. 46 APRIL 1996

HIV/AIDS KNOWLEDGE SERIES NO. 46 APRIL 1996 HIV/AIDS KNOWLEDGE SERIES NO. 46 APRIL 1996 AIDS: THE PREVENTABLE EPIDEMIC Curriculum and Guide for Kindergarten-12, written by the Oregon Health Division and the Department of Education, is currently

More information

How can clinical psychologists help with chronic pain?

How can clinical psychologists help with chronic pain? University Teaching Trust How can clinical psychologists help with chronic pain? Irving Building Pain Centre 0161 206 4002 All Rights Reserved 2017. Document for issue as handout. Why have you been referred

More information

Glossary 3189 Report - Discontinued 2007 see Supplemental Vaccine Certification Form

Glossary 3189 Report - Discontinued 2007 see Supplemental Vaccine Certification Form Glossary 3189 Report - Discontinued 2007 see Supplemental Vaccine Certification Form 3231 Report see Certificate of Immunization ACIP Advisory Committee on Immunization Practices. Along with the Centers

More information

HIDDEN VILLA RETREAT APPLICATION

HIDDEN VILLA RETREAT APPLICATION INSIGHT MEDITATION CENTER HIDDEN VILLA RETREAT APPLICATION March 20 to March 27, 2011 For questions, contact Donna C. Wilhelm dona@mlode.com (preferred way to contact) Or phone her at 209-533-3656 This

More information

On behalf of JDRF, we are looking forward to working with you. Together, we can make a difference!

On behalf of JDRF, we are looking forward to working with you. Together, we can make a difference! Dear Prospective or Returning JDRF Youth Ambassador: We would like to invite you to participate in the 2017 JDRF Youth Ambassador Program. This group is made up of children and their families living with

More information

What can you do as a parent?

What can you do as a parent? Gillian Chapman, Ed.D. Superintendent, TCSD#1 PO Box 568 Jackson, WY 83001 TCSD Families and Community Members, In the wake of the most recent school shooting in Florida, I wanted to assure you that we

More information

Longwood Teen Volunteer Program 2018

Longwood Teen Volunteer Program 2018 Longwood Teen Volunteer Program 2018 The Longwood Teen Volunteer Program is an eight-week summer program from June 18 August 9 that provides high school students with an opportunity to be part of a team,

More information

Round Rock Sertoma General Scholarship Application for Students who are Hard of Hearing or Deaf

Round Rock Sertoma General Scholarship Application for Students who are Hard of Hearing or Deaf Round Rock Sertoma General Scholarship Application for Students who are Hard of Hearing or Deaf Deadline: March 1 of your Senior Year Scholarship Program $1,000 scholarship to cover tuition, books and

More information

High School Sexual Health Curriculum Overview

High School Sexual Health Curriculum Overview High School Sexual Health Curriculum Overview Rights, Respect, Responsibility The Advocates for Youth s Rights, Respect, Responsibility curriculum is based on the belief that: Youth have the right to honest

More information

APPLICATION INSTRUCTIONS

APPLICATION INSTRUCTIONS APPLICATION INSTRUCTIONS This application is a six (6) page document dated 8/2015 1. Pages 1 and 2 of the application is the INFORMATION FOR PARENT/GUARDIAN to read and keep... 2. Pages 5 and 6 of the

More information

Caring for Someone with an Eating Disorder. nedc.com.au

Caring for Someone with an Eating Disorder. nedc.com.au Caring for Someone with an Eating Disorder nedc.com.au 2015 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your

More information

Participant Information Sheet

Participant Information Sheet Appendix A Participant Information Sheet for Young People Participant Information Sheet Exploring experiences of disclosure and non-disclosure amongst young adolescents who hear voices Hi. My name is Rachel

More information

Tennessee State University Department of Speech Pathology & Audiology

Tennessee State University Department of Speech Pathology & Audiology Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp 2014 Speech Pathology and Audiology will provide intensive

More information

Restorative Practices in Schools. District Attorney Joseph Early Jr. Safe Schools Summit October 1, 2015

Restorative Practices in Schools. District Attorney Joseph Early Jr. Safe Schools Summit October 1, 2015 Restorative Practices in Schools District Attorney Joseph Early Jr. Safe Schools Summit October 1, 2015 Presentation Goal and Objectives Goal: Participants will understand Restorative Practices as an effective

More information

IRB policy and procedures 1. Institutional Review Board: Revised Policy and Procedures Elmhurst College

IRB policy and procedures 1. Institutional Review Board: Revised Policy and Procedures Elmhurst College IRB policy and procedures 1 Institutional Review Board: Revised Policy and Procedures Elmhurst College IRB policy and procedures 2 Table of Contents A. Purpose and objectives... p. 3 B. Membership of the

More information

Focus of Today s Presentation. Partners in Healing Model. Partners in Healing: Background. Data Collection Tools. Research Design

Focus of Today s Presentation. Partners in Healing Model. Partners in Healing: Background. Data Collection Tools. Research Design Exploring the Impact of Delivering Mental Health Services in NYC After-School Programs Gerald Landsberg, DSW, MPA Stephanie-Smith Waterman, MSW, MS Ana Maria Pinter, M.A. Focus of Today s Presentation

More information

Following this letter are health forms for parents or legal guardians to complete and sign. Please note that:

Following this letter are health forms for parents or legal guardians to complete and sign. Please note that: Summer Pre-College Programs Dear Summer Pre-College Student and Family, Welcome to Marist College! Please review the attached Health Forms. Students will be informed of health and emergency information

More information

Mid Essex Specialist Dementia and Frailty Service

Mid Essex Specialist Dementia and Frailty Service Mid Essex Specialist Dementia and Frailty Service Why have you been referred to us? What service can you expect? You have the right to be treated with dignity and respect. You and your loved ones also

More information

Sunshyne Smiles Program Orthodon c Assistance Applica on (to be completed by parent/guardian)

Sunshyne Smiles Program Orthodon c Assistance Applica on (to be completed by parent/guardian) Orthodon c Assistance Applica on (to be completed by parent/guardian) Child s (First) (MI) (Last) Birthdate: Sex: Male Female Parent/Guardian Name (s): Address: City/State/Zip: (First) (MI) (Last) Daytime

More information

Substance Prevention

Substance Prevention First Name Last Name Period Substance Prevention POINTS ASSIGNMENT /65 pts Worksheet Total /10 pts Book Activity Page /10 pts Group Discussion on Substance Use in Teenagers /10 pts Teenage Drinking Brain

More information

Grade 8 Immunization Package

Grade 8 Immunization Package Grade 8 Immunization Package Tetanus, Diphtheria, Pertussis Vaccine Vaccines have saved more lives in Canada in the last 60 years than any other medical intervention. Vaccines help your immune system to

More information

JDRF Oklahoma. Youth Ambassador Program 2017 Promise Ball 20 th Anniversary. Information Packet

JDRF Oklahoma. Youth Ambassador Program 2017 Promise Ball 20 th Anniversary. Information Packet JDRF Oklahoma Youth Ambassador Program 2017 Promise Ball 20 th Anniversary Information Packet Dear Prospective JDRF Youth Ambassador: I am writing to invite you to participate in the 2017 JDRF Youth Ambassador

More information

Baa Hózhó Navajo Prep Math Summer Camp 2017

Baa Hózhó Navajo Prep Math Summer Camp 2017 Math Summer Camp 2017 Application Packet Grades 7-12 May 30-June 3, 2017 Navajo Preparatory School, Farmington, NM Residential Camp Application Checklist A complete application must include the following:

More information

suicide Part of the Plainer Language Series

suicide Part of the Plainer Language Series Part of the Plainer Language Series www.heretohelp.bc.ca What is? Suicide means ending your own life. It is sometimes a way for people to escape pain or suffering. When someone ends their own life, we

More information

The Role of High School Teachers in Preventing Suicide. Teachers: Understand Why Suicide Prevention Is Important. Know the facts

The Role of High School Teachers in Preventing Suicide. Teachers: Understand Why Suicide Prevention Is Important. Know the facts The Role of High School Teachers in Preventing Suicide Ms. Gomez, a high school social studies teacher, was concerned about her student Tia because she knew she had problems at home. One day she heard

More information

New York Certified Peer Specialist

New York Certified Peer Specialist New York Certified Peer Specialist PROVISIONAL Application New York Peer Specialist Certification Board 11 North Pearl Street, Suite 801 Albany New York 12207 Phone: 518.426.0945 Fax: 518.426.1046 www.nypeerspecialist.org

More information

PSYCHOLOGIST-PATIENT SERVICES

PSYCHOLOGIST-PATIENT SERVICES PSYCHOLOGIST-PATIENT SERVICES PSYCHOLOGICAL SERVICES Welcome to my practice. Because you will be putting a good deal of time and energy into therapy, you should choose a psychologist carefully. I strongly

More information

Conducting Outreach on Manhunt.net

Conducting Outreach on Manhunt.net Conducting Outreach on Manhunt.net This guidance has been created in an effort to assist your organization in the creation of a profile designed to provide outreach to the members of Manhunt.net. This

More information

DIABETES PACKAGE FOR PARENTS/GUARDIANS

DIABETES PACKAGE FOR PARENTS/GUARDIANS HALTON CATHOLIC DISTRICT SCHOOL BOARD DIABETES PACKAGE FOR PARENTS/GUARDIANS ELEMENTARY SCHOOLS JUNE 2009 PARENT/GUARDIAN INFORMATION AND RESPONSIBILITIES DIABETES MANAGEMENT PROTOCOL A collaborative effort

More information

INSTRUCTION BP SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION

INSTRUCTION BP SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION SECTION 6000 BOARD POLICY INSTRUCTION BP 6142.1 SEXUAL HEALTH AND HIV/AIDS PREVENTION INSTRUCTION The Governing Board desires to provide a well-planned, integrated sequence of medically accurate and inclusive

More information

Violence, Threat and Risk Assessment Protocol. 4.9 Violence, Threat, Risk Assessment Protocol (April 2016)

Violence, Threat and Risk Assessment Protocol. 4.9 Violence, Threat, Risk Assessment Protocol (April 2016) 4.9 Violence, Threat, Risk Assessment Protocol (April 2016) Developed in consultation with Safer Schools Together guidelines. Policy Sikh Academy will take steps to ensure the safety of its students, staff

More information

ACTION PLAN FOR. Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Wheeze or persistent cough ACTION FOR ANAPHYLAXIS

ACTION PLAN FOR. Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Wheeze or persistent cough ACTION FOR ANAPHYLAXIS www.allergy.org.au Name: Date of birth: Photo Confirmed allergens: Family/emergency contact name(s): ACTION PLAN FOR Anaphylaxis SIGNS OF MILD TO MODERATE ALLERGIC REACTION Swelling of lips, face, eyes

More information

Calumet 2017 staff/trainee/volunteer Health History & Examination Form PO Box 236, West Ossipee, NH Fax

Calumet 2017 staff/trainee/volunteer Health History & Examination Form PO Box 236, West Ossipee, NH Fax Calumet 2017 staff/trainee/volunteer Health History & Examination Form PO Box 236, West Ossipee, NH 03890 The information on this form is to assist us in determining appropriate care for staff/trainees/volunteers.

More information

6th grade ICR GHOST pre-activity

6th grade ICR GHOST pre-activity 6th grade ICR GHOST pre-activity 6.ICR.1.1 - Classify behaviors as either productive or counterproductive to group functioning. A well-functioning group will exhibit the following behaviors: 1. Collaboration

More information

INTERCOLLEGIATE ATHLETICS RETURNING STUDENT-ATHLETE MEDICAL FORMS CHECKLIST

INTERCOLLEGIATE ATHLETICS RETURNING STUDENT-ATHLETE MEDICAL FORMS CHECKLIST RETURNING STUDENT-ATHLETE MEDICAL FORMS CHECKLIST Dear PC Student-Athletes, Welcome back to Aberdeen. We are excited to see you return to continue your pursuit of athletic excellence and academic success.

More information

Cambridge Public Schools SEL Benchmarks K-12

Cambridge Public Schools SEL Benchmarks K-12 Cambridge Public Schools SEL Benchmarks K-12 OVERVIEW SEL Competencies Goal I: Develop selfawareness Goal II: Develop and Goal III: Develop social Goal IV: Demonstrate Goal V: Demonstrate skills to demonstrate

More information

Safety and Managing Risk

Safety and Managing Risk 8 Safety and Managing Risk Aim: To understand and manage the balance between risk and safety in relation to physical and emotional well-being. Emotional Safety Activity 1 What Pushes My Buttons? Activity

More information

Talking to Teens About Anxiety. A Supplement to the 2018 Children s Mental Health Report

Talking to Teens About Anxiety. A Supplement to the 2018 Children s Mental Health Report Talking to Teens About Anxiety A Supplement to the 2018 Children s Mental Health Report Everyone talks about how stressed they are, but getting teens to open up about serious anxiety isn t easy. Sometimes

More information

Suicide Risk Assessment Demian Laudisio, Florida Youth Suicide Prevention Project Manager

Suicide Risk Assessment Demian Laudisio, Florida Youth Suicide Prevention Project Manager Suicide Risk Assessment Demian Laudisio, Florida Youth Suicide Prevention Project Manager Switchboard, Inc. Switchboard counsels, connects and empowers people in need Switchboard Suicide Prevention Dept.

More information

How Well Do You Know Tompkins County Youth?

How Well Do You Know Tompkins County Youth? Communities that Care Youth Survey Summary Highlights Tompkins County Spring, 2015 Community Coalition for Healthy Youth www.healthyyouth.org Tompkins County Youth Services Dept. www.tompkinscountyny.gov/youth

More information

USER GUIDE. The Jason Foundation, Inc. 18 Volunteer Drive Hendersonville, TN jasonfoundation.com iwontbesilent.com

USER GUIDE. The Jason Foundation, Inc. 18 Volunteer Drive Hendersonville, TN jasonfoundation.com iwontbesilent.com USER GUIDE The Jason Foundation, Inc. 18 Volunteer Drive Hendersonville, TN 37075 jasonfoundation.com iwontbesilent.com ARE YOU UP FOR THE CHALLENGE? The unfortunate news is that suicide is the 2nd leading

More information

ADHD Information and Instructions

ADHD Information and Instructions ADHD Information and Instructions This ADHD information packet will answer many of the questions you may have concerning your child s appointment. Please read everything carefully prior to your visit and

More information