Asthma Friendly Schools Award Application
The Vermont Department of Health and the American Lung Association are pleased to announce Vermont’s first Asthma-Friendly Schools Award program for K-12 schools! This award will be given to Local Education Agencies (LEAs) that show the biggest commitment to fostering asthma-friendly environments in their schools. Awards will be given to a maximum of three LEAs and will have the potential to reach $2,000 per award. To apply, please complete the survey below by April 13, 2018. The winners will be recognized in a special ceremony in May.
Email address *
1. What number of schools do you have within your Local Education Agency (LEA)? - requires no comma in the number *
Your answer
2. What is the total student enrollment in your LEA? *
Your answer
3. How many licensed school nurses work within your LEA? (list as full-time equivalent) *
Your answer
4. What number of the schools within your LEA have conducted or have formally scheduled an Envision walk through this school year? (maximum points = 100) http://www.healthvermont.gov/health-environment/healthy-schools/envision-program *
Your answer
5. What number of the schools within your LEA have implemented or are implementing Open Airways for Schools this school year? (maximum points = 100) http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-education-advocacy/open-airways-for-schools/ *
Your answer
6. What number of schools within your LEA obtain a written asthma action plan for at least 70% of students with asthma every year? (maximum points = 100) http://www.healthvermont.gov/sites/default/files/documents/2016/11/Annual%20Asthma%20Action%20Plan_2016_08_26_1.pdf *
Your answer
7. What number of schools within your LEA have an asthma emergency plan in the staff and student/parent handbooks? (maximum points = 100) *
Your answer
8. Does your LEA have a Whole School, Whole Community, Whole Child (WSCC) team or equivalent that addresses indoor air quality and meets at least two times per year? (maximum points = 100) http://www.healthvermont.gov/children-youth-families/school-health/whole-school-whole-community-whole-child *
9. How does your LEA ensure that staff receive education on asthma basics, asthma management and emergency response? (maximum points = 10) *
Your answer
10. What number of schools within your LEA use an electronic health record (EHR) to identify, track, and maintain current individual health plans for students with asthma? (maximum points = 5) *
Your answer
11. How does your LEA enforce the state law that bans the use of cigarettes, tobacco products, and tobacco substitutes (e.g. e-cigarettes) on school property, school buses, and at school-sponsored events as described in 16 V.S.A. § 140? (maximum points = 5) https://legislature.vermont.gov/statutes/section/16/001/00140 *
Your answer
12. How does your LEA ensure students’ right to self-carry and self-administer prescribed asthma medication as described in 16 V.S.A. § 1387? (maximum points = 5) https://legislature.vermont.gov/statutes/section/16/031/01387 *
Your answer
13. How does your LEA enforce vehicle idling policies on school grounds and at school-sponsored events as described in 23 V.S.A. § 1282 (f) and 23 V.S.A. § 1110 (maximum points = 5) https://legislature.vermont.gov/statutes/section/23/013/01282 https://legislature.vermont.gov/statutes/section/23/013/01110 *
Your answer
14. What number of schools within your LEA prohibit parents, teachers and staff from bringing in non-third-party certified cleaning products? (maximum points = 5) *
Your answer
15. What number of schools within your LEA have a written indoor air quality (IAQ) management plan that reduces or eliminates allergens and irritants? (maximum points = 5) *
Your answer
16. Bonus Question: Do you have a story you would like to share that highlights why your LEA should receive the Asthma-Friendly Schools Award? (maximum points = 20)
Your answer
17. Is there anything else you want to share about the answers above or the schools within your LEA? (no points)
Your answer
What is your name? *
Your answer
What is your title? *
Your answer
What is the name of your LEA? *
Your answer
What is your daytime phone number? *
Your answer
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