The Healthy Georgia Awards: Community/Municipality Application

The 2017 Healthy Georgia Award application is now available!

Deadline to submit application:11:59PM September 17, 2017
Please collect all information and supporting documentation prior to submitting online application.
Criteria documentation can be shared via a web-based file sharing program (e.g. Google Drive, Dropbox).
Completed applications must be approved by the Mayor, Chair of the City Council or Board of Commission Chair prior to submission.
If you have any questions, please contact us at [email protected]

Please enter your Community or Municipality Name (required)

Primary Contact Name (required)

Primary Contact Position/Role (required)

Primary Contact Email (required)

Primary Contact Phone Number (required)

Name of Mayor, Chair of the City Council or Board of Commission Chair (required)

Email for the person above (required)

Street Address (required)

City/Zip Code (required)

City/County Population (required)

Do you have an employee responsible for your organization’s health and wellness efforts?

Yes

When did your city or county begin health and wellness programs or interventions?

What is the estimated number of children (aged 0-18) you impact annually with your health and wellness programming?

In 250 words or less, please briefly explain how you reached this population.

In 250 words or less, please explain your city or county’s health and wellness programing/interventions.

How many performance measures have you collected that demonstrate improvement or success of your programming?

In 150 words or less, please explain each of the performance measures outlined above that demonstrate improvement or success in your programming.

Please indicate if any of these measures of improvement are related to child health and wellness knowledge and/or behavior change. If none of them do, please answer NA.

• Have you shared your results with other communities or through other media/news outlets? If so, in 50 words or less, please explain how you shared your results and with what outlets.

emailvideos

Note regarding video uploads: Please email videos separately to [email protected]

Please upload any media releases or supporting documents here. (Combine all files into a single .pdf to upload)

One file only.
2 MB limit.
Allowed types: pdf.

Please upload any photos here. (Additional points will be awarded if you provide at least 5 photos.)

Combine all photos into a single word or power point and convert to a single .pdf file. Email videos to [email protected]
One file only.
2 MB limit.
Allowed types: pdf.

Would you be interested in receiving Georgia Shape information in the future?

Yes

The Healthy Georgia Awards: Community/Municipality Application

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