The Healthy Georgia Awards Non-Profit 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 organization’s President or CEO prior to submission.
If you have any questions, please contact us at [email protected]

Organization's Name (required)

Primary Contact (required)

Primary Contact Position/Role (required)

Primary Contact Email (required)

Primary Contact Phone Number (required)

Name of President or CEO (required)

President/CEO's Email (required)

Organization Street Address (required)

Organization City/State/Zip (required)

How many people does your Organization employ? (required)

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

Yes

When did your Organization 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?

Please briefly explain in 250 words or less how you reached this population.

In 250 words or less, please explain your organizations health and wellness programming/interventions.

How many performance measures have you collected that demonstrate the 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.

Please indicate if any of these measures of improvement are related to policy, environmental and/or system change or improvement. If none of them are, 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.

emailto

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

Please upload any media releases or supporting documents here.

Please combine all files and supporting documents into a single .pdf file.
One file only.
2 MB limit.
Allowed types: pdf.

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

Please combine all photos into a single file, send videos separately to mailto: [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 Non-Profit Application

Call Us

Visit

Hours