Healthy School Liaisons & Employee Wellness Liaisons Form 2020-21
Jeffco Healthy Schools is identifying liaisons and goals for the 2020-21 school year. Liaisons act as a conduit between the district and schools/departments as well as promote student and staff wellness.

SCHOOLS- COMPLETE THE FORM BELOW!
Submit one form per school. To see if your school submitted: https://tinyurl.com/v4t52da

DEPARTMENTS (i.e Food Service, Transportation, Human Resources, Special Education) To designate Employee Wellness Liaisons visit: https://forms.gle/Q5w2f3ko8X61U4qLA

Email address *
Healthy Schools Information
I understand the following regarding Healthy Schools *
Required
Healthy Schools Team Info
School Name (Dept Name) *
Which describes your school? *
Does your school have a healthy schools team/wellness committee? *
Teams must have at least 2 people, meeting at least 4-5 times a year. Typically a team has 5-8 staff, students and/or parents representing health across the school building.
Contact Info
Healthy Schools Liaison #1 *
This is the person who will receive a confirmation email with a copy of your submission.
Healthy Schools Liaison #1 Email *
Healthy Schools Liaison #1 Role or Title *
Healthy Schools Liaison #2
We STRONGLY recommend having two leaders.
Healthy Schools Liaison #2 Email
Healthy Schools Liaison #2 Role or Title
Clear selection
Employee Wellness Liaison
Liaisons act as a conduit between the district employee wellness team and the school/department. Liaisons share and promote resources and campaigns with their schools. This can be one of the above Healthy Schools Liaisons or a different staff person.
Employee Wellness Liaison Email
Any additional people who want to be on our contact list?
Please list EMAILS separated by semicolon
Does your school have a STUDENT-LED healthy schools team? *
A team in which students make up most of the membership and decision-making authority.
Healthy Schools Goals
A best practice is to have annual health and wellness goals at your school. Please identify your goals below.
See examples here: https://goo.gl/WYClAv.

Schools often use their Healthy Schools Smart Source or Jeffco Healthy Schools Checklist results to help identify their goals. This tool is also useful to identify best practices for your school. See inventory of questions here: https://drive.google.com/file/d/1yDvZDBaEtTyiAvXdgzcyT7-j_ahVA8Ol/view
Healthy Schools Goal #1
Goal #1 - Select (or write in) one area for your first goal *
Share a short description (2-3 sentences) of how your school might accomplish this goal.
This helps Jeffco Healthy Schools know what resources are needed in the district.
Healthy Schools Goal #2
Goal #2 - Select (or write in) one area for your second goal
Clear selection
Share a short description (2-3 sentences) of how your school might accomplish this goal.
This helps Jeffco Healthy Schools know what resources are needed in the district.
By checking below, I verify that we have our principal's permission and support to implement these goals. *
Required
You are done! Hit SUBMIT and Jeffco Healthy Schools will be in touch soon!
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