Sixth Annual Governor s Fitness Awards Call for Nominations Governor s Council on Physical Fitness, Health and Sports Governor s Council on Physical Fitness, Health and Sports and Michigan Fitness Foundation Fostering prosperity by empowering, facilitating and celebrating healthy choices. Our mission is to encourage Michiganders to take responsibility for their health by creating a physically educated population with the knowledge and skills to enjoy a healthy, vigorous and safe lifestyle in communities designed to support physical activity. The Governor s Fitness Awards The purpose of the Governor s Fitness Awards is to recognize individuals, organizations and events that encourage others to make healthy choices by teaching, volunteering, role modeling or through other community involvement. The Awards Reception serves as a platform for appreciation and public recognition for these deserving citizens as well as a fundraiser for the Michigan Fitness Foundation. Nominate an individual or organization for one of the categories below to help honor their commitment to making Michigan a healthier state. Governor s Council Public Officials Award Honors a public official for advocating and promoting healthy living through his/her public role. Governor s Council Champion for Health Award Honors an individual for his/her work promoting healthy lifestyles at a grassroots level. Charles T. Kuntzleman Accepting the Challenge Award Recognizes individuals who have overcome great challenges to pursue physical activity as a part of their daily life. Governor s Council Outstanding Healthy Workplace Award Honors workplaces that promote and encourage wellness, physical fitness and healthy living. Governor s Council Extraordinary Event/Organization Award Honors events or organizations that provide physical fitness opportunities for the public at large in an exceptional way. Vern Seefeldt Lifetime Achievement Award Recognizes an individual who has made landmark contributions to the health of Michigan residents through research, teaching, professional practice, policy or volunteer involvement related to physical activity or fitness. Governor s Council Conquering Obesity Award Honors an individual or group that has conquered obesity through dedication to physical activity and healthy eating. The Governor s Council Inspiring Story Award Honors an inspiring story of an individual or team overcoming adversity. The Governor s Council Veteran of the Year Award Honors a veteran who has gone Above and Beyond to promote healthy living either through personal or professional endeavors.
Nomination Sixth Annual Form Governor s Fitness Council Awards Public Officials Award Eligible individuals are advocates and spokespeople for healthy living. Furthermore, through their public role they must have demonstrated a commitment to policies that support physical education, active communities and programs that support and encourage physical activity. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Governor s Council Public Officials Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe the nominated individuals commitment to creating policies that support physical education and active communities. Be sure to include any specific bills or policies the individual has supported. (5 points) 2. Describe how this public official has served as a role model for healthy living. (10 points) 3. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)
Nomination Sixth Annual Form Governor s Fitness Council Awards Champion for Health Award Most communities have an individual or two who are always working to improve the health of its citizens. This could be someone who provides free bicycle helmets to neighborhood children; a community organizer who hosts a weekly farmer s market; a parent who advocates for quality physical and health education in his/her child s school; a fitness instructor who passionately encourages people of all skill levels to exercise. These are individuals who work on a grassroots level to make their communities healthier places to live for no other reason other than that it is the right thing to do. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Governor s Council Champion for Health Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe the work the nominated individual does to make his or her community a healthier place. Please include background information that highlights the inspirational nature of this individual s commitment. (5 points) 2. What was the catalyst for this individual to take on this work? (3 points) 3. What has leading this grassroots effort meant to him/her (include a description of the internal and external rewards for the individual). (2 points) 4. How has leading this grassroots effort influenced or inspired others? (5 points) 5. How long has the nominee been a part of this effort? (2 points) 6. Describe the individual s time commitment around this effort. (2 points) 7. Please list any other recognition or acknowledgement this person has received (newspaper stories, television interviews, awards, etc.). (1 point) 8. In addition to what you ve already told us, please share any personal observations or factors that make this person an excellent choice for this honor. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)
Nomination Sixth Annual Form Governor s Charles T. Fitness Kunzleman Awards Accepting the Challenge Award Recipients of this award have overcome great challenges to pursue physical activity as part of their daily routine.the Charles T. Kuntzleman Accepting the Challenge Awards are named after the former Chair of the Governor s Council and Michigan Fitness Foundation. His vision and leadership helped to shape the organization, impacting the lives of more than one million Michiganders. Dr. Kuntzleman is the author of several books including They Accepted the Challenge, describing people who, despite great obstacles, have pursued a life of physical activity. He is an internationally renowned fitness and health expert, and was inducted into the National Fitness Hall of Fame in March 2008. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Charles T. Kuntzleman Accepting the Challenge Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe any obstacles the nominee has overcome in order to make physical activity a part of his/her regular routine. Please include background information that highlights the inspirational nature of this individual s commitment. (4 points) 2. What was the catalyst for this individual to become physically active? (5 points) 3. What has overcoming those challenges meant to him/her (include a description of the internal and external rewards for the individual). (4 points) 4. How has overcoming those challenges influenced or inspired others? (4 points) 5. How long has the nominee been physically active? Describe the nominee s physical activity routine (days of the week, minutes per session, type of physical activity, etc.). (4 points) 6. Please list any other recognition or acknowledgement this person has received (newspaper stories, television interviews, awards, etc.). In addition to what you ve already told us, please share any personal observations or factors that make this person an excellent choice for this honor. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)
Nomination Sixth Annual Form Governor s Fitness Council Awards Outstanding Healthy Workplace Award To be considered for this award, an organization must demonstrate its support for healthy lifestyles through its missions, programs or policies. The winning organization should have a well-developed wellness program and opportunities for employees to incorporate health into their daily routine. The recognized workplace might encourage employees to get fit by hosting fitness challenges, providing healthy snacks in the break room or inspire employees to work out during their breaks. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your relationship to the nominated organization:
Nomination Form Continued Governor s Council Outstanding Healthy Workplace Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe the organization s work that supports healthy lifestyles. Be sure to include specific programs or events that promote physical activity and or nutrition. (4 points) 2. What strategies does the organization use to track and measure the success of wellness programs? (4 points) 3. Discuss the organization s leadership system. How do leaders provide support and encouragement to employees? (4 points) 4. What policies and benefit options does the organization provide their employees? How do the policies and benefit options support wellness? (4 points) 5. Describe the organization s community involvement. What philanthropic events does the organization participate in? (4 points) 6. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)
Nomination Sixth Annual Form Governor s Fitness Council Awards Extraordinary Event/Organization Award This award honors an event or organization that provides physical fitness opportunities to the public at large. The winning organization or event offers citizens the opportunity to develop their physical fitness skills and education of wellness and health in an environment that fosters positive health behaviors. The winning event or organization works to encourage citizens at all skill levels to exercise and improve their understanding of health by hosting a 5K run and walk, a beginner s yoga class or a healthy-foods cooking class. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your relationship to the nominated organization
Nomination Form Continued Governor s Council Extraordinary Event/Organization Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Please provide a brief history of the event/organization. Highlight the service the event/ organization aims to provide within the community (4 points) 2. Describe the steps the organization/event takes to providing a safe and welcoming environment for organization members/participants. (4 points) 3. How does the organization/event encourage physical activity to a range of citizens of all ages and capabilities? (4 points) 4. How does the organization/event educate community members about health and wellness? (4 points) 5. Has the organization/event impacted the design of the community s infrastructure or recreational spaces? How? (4 points) 6. If applicable, please list any other recognition or nomination the organization/event has received, along with press clippings or other support material. (5 points)
Nomination Sixth Annual Form Governor s Vern Fitness Seefeldt Awards Lifetime Achievement Award The award recognizes individuals who, over a lifetime, have made landmark contributions to the health of Michigan residents through research, teaching, professional practice, policy or volunteer involvement related to physical activity or physical fitness. The award is named for its first recipient, Dr. Vern Seefeldt. Dr. Seefeldt was the first Chair of the Michigan Governor s Council on Physical Fitness, Health and Sports, appointed in 1992 by Governor John Engler. He began his career as a high school science teacher but eventually became the director of the Youth Sports Institute at Michigan State University, earning national recognition for leadership in many physical education-related programs. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Vern Seefeldt Lifetime Achievement Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe the nature and quality of the nominees contributions, including number of years of service. (10 points) 2. How many individuals have been affected by the individual and what is the magnitude of the individual s effect? (5 points) 3. Describe how this individual has served as a role model for healthy living. (5 points) 4. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)
Nomination Sixth Annual Form Governor s Fitness Council Awards Conquering Obesity Award Honors an individual or group that has conquered obesity through dedication to physical activity and healthy eating. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Governor s Council Conquering Obesity Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe any obstacles the nominee has overcome in order to make physical activity and healthy eating a part of his/her regular routine. Please include background information that highlights the inspirational nature of this individual s commitment. 2. What was the catalyst for this individual to make a lifestyle change? 3. Describe the lifestyle changes the individual to make a lifestyle change? 4. How has the individual inspired or influenced others to make positive lifestyle changes? 5. Please list any other recognition or acknowledgement this person has received (newspaper stories, television interviews, awards, etc.). In addition to what you ve already told us, please share any observations or factors that make this person an excellent choice for this honor.
Nomination Sixth Annual Form Governor s Fitness Council Awards Inspiring Story Award This award honors an inspiring story of an individual or team who overcame adversity to reach success in their health and fitness endeavor. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Governor s Council Inspiring Story Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Please provide a brief history of the individual/team. Highlight the vision and/or goals of the individual/team. (5 points) 2. Describe the steps the individual/team took to achieve their goals. (5 points) 3. How has the individual inspired or influenced others to make positive lifestyle changes? (5 points) 4. How does the individual/team equip others with the knowledge and tools to make choices for healthy lifestyle? (5 points) 5. If applicable, please list any other recognition or nomination the individual/team has received. (5 points)
Nomination Sixth Annual Form Governor s Fitness Council Awards Veteran of the Year Award This award honors a veteran who has gone Above and Beyond to promote healthy living in either a personal or professional setting. Nominee Name Nominee Address Nominee City, State, ZIP (Must be a Michigan resident) Nominee County Nominee Phone ( ) - Nominee Email Nominee Age Nominee Race Nominee Gender M F Your Name (First) (M.I.) ( Last) Your Phone Number ( ) - Your Address Your Email Your Relationship to the Nominee I am nominating myself
Nomination Form Continued Governor s Council Veteran of the Year Award Selection Criteria: Please provide response on a separate sheet of paper (please limit to 500 words). 1. Describe the nature and quality of the nominee s contributions, including number of years of service. (10 points) 2. How many individuals have been affected by the individual and what is the magnitude of the individual s effect? (5 points) 3. Describe how this individual has served as a role model for healthy living. (5 points) 4. Include letters of recommendation, newspaper clippings or any additional supporting materials. (5 points)