Asthma Friendly Schools Award Application
The Vermont Department of Health and the American Lung Association are pleased to present Vermont’s Fourth Annual 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 May 31. Winners will be notified in June. Thank you!
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1. What number of schools do you have within your Local Education Agency (LEA)? *
2. What is the total student enrollment in your LEA? *
3. How many licensed school nurses work within your LEA? (list as full-time equivalent) *
4. What number of the schools within your LEA have conducted or have formally scheduled an Envision environmental walk through this school year? (maximum points = 100)   http://www.healthvermont.gov/health-environment/healthy-schools/envision-program *
5. What number of the schools within your LEA have implemented or are implementing Asthma Self-Management Education (e.g. 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/ *
6. What number of schools within your LEA obtained a written asthma action plan for at least 70% of students with asthma for the 2017-2018 school nurse report year? (maximum points = 100) http://www.healthvermont.gov/sites/default/files/documents/2016/11/Annual%20Asthma%20Action%20Plan_2016_08_26_1.pdf *
7. What number of schools within your LEA have an asthma emergency plan in the staff and student/parent handbooks? (maximum points = 100) *
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. Did your school make HVAC improvements to increase ventilation, improve filtration and/or address humidity? (maximum points = 50) *
10. How many schools in your LEA exceed the state average of 72% of students whose parents report the child received an annual well-child exam (maximum points = 40) *
11. What training did your LEA provide last year to ensure that all staff members receive education on asthma basics, asthma management and emergency response? (maximum points = 10) *
12. 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) *
13. 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 *
14. 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 *
15. 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 *
16. How does your LEA prohibit parents, teachers and staff from bringing in non-third-party certified cleaning products? Please provide an example (maximum points = 5) *
17. 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) *
18. 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)
19. Do you know an asthma champion who has worked hard to advance asthma friendly practices that support children in their local communities? Please nominate them here for an Asthma Friendly Champion Award.
What is your name? *
What is your title? *
What is the name of your LEA? *
What is your daytime phone number? *
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