Please review the information below. If everything is correct, click “Send”. To go back and edit your entries, click “Edit”.
Error: The following required items were not provided or are in the wrong format. Please provide the required responses and submit again:
Current School Demographics
If you are unable to report this data, please explain why. (500 character limit including spaces)
A capacity and willingness to form or support an existing team that supports school mental health and wellness should include staff with decision making power and staff who will support implementation efforts and ultimately include student and caregiver voice. Who do you anticipate serving on your team?
Please include the role at the school and the names of the proposed team members when possible. (2,000 character limit including spaces)
Data Collection
Does your school collect types of student level mental health or wellness data?
If yes, please select and/or describe the type of student level mental health or wellness data your school collects.
Please describe (500 character limit including spaces)
If your school does not collect student level mental health or wellness data is the school willing to start collecting this type of data with guidance from the implementation coaches?
If unsure, please briefly explain. (500 character limit including spaces)
Additional Information
How would you best describe the school’s current culture around student and staff mental wellness?
For example, you may include information around trauma responsive practices, culturally responsive practices, school safety, restorative discipline and bullying response practices, staff wellness, climate, mental health stigma reduction, OR student belonging. (2,000 character limit including spaces)
If applicable, please list any community organizations that support the school community mental wellness or provide mental wellness services within the school and briefly explain the provided services. We understand that not all schools have these partnerships and anticipate inviting schools that do and do not identify community partners to complete the application process. (2,000 character limit including spaces)
Please indicate agreement with the following best practices.
We agree to complete a needs assessment with the support of an implementation coach provided by United Way through Empowering Minds.
We agree to gather regularly (for example, 4-8 times per school year) as a team to engage in cycles of improvement with the support of an implementation coach.
We agree to share the results of our needs assessment with Empowering Minds/United Way (identifying data will not be shared).
We agree to collect and share with Empowering Minds/United Way student and school level data measuring progress towards a comprehensive school mental health system.
We agree that students, families, staff and membership on the governing board are served, employed or appointed without regard to social or economic class, gender, gender identity, age, sexual orientation and identification, disability, special health care needs, race, color, national origin or religion. Organizations with a religious affiliation must not refuse services to a participant based on religion or require attendance or participation in religious services/activities as a condition of services.
School Administrator Letter (Required)
- Please download and use this template for the school administrator to sign. This letter is an agreement to the above best practices and to the application steps if your school is invited to apply.
- Please only edit the date, school name, and contact information.
- Once the letter has been completed and signed, please upload a copy to the shared drive here.