Site Application-Site Coordinator

I Can Do It, You Can Do It

ICDI Site Application Form

Site Application-Site Coordinator

OMB: 0990-0463

Document [docx]
Download: docx | pdf



I Can Do It, You Can Do It! Program


Overview:

The I Can Do It, You Can Do It! (ICDI) program recognizes the importance of working with a variety of sectors to improve access for people of all backgrounds and abilities to participate in physical activity, sports, and recreation opportunities. We invite organizations and individuals to join us in our work supporting the mission of the President’s Council on Fitness, Sports & Nutrition (PCFSN), which is to engage, educate, and empower all Americans across the lifespan to adopt a healthy lifestyle that includes regular physical activity and good nutrition.


The Goal:

The goal of the ICDI Program is to increase the number of opportunities for children and adults with disabilities to lead a healthy, active lifestyle where they live, learn and play. To accomplish this goal, PCFSN is calling on stakeholders in schools and school districts, colleges and universities, and other community entities such as faith-based organizations, rehabilitation facilities, physical therapy clinics and community health centers to sign up to be an ICDI Site.


ICDI Sites are stakeholders who are currently implementing or would like to establish a health promotion program for children and/or adults with disabilities in a school-, college and university-, or other community-based setting.


What are the benefits to being an ICDI Site?

  • FREE access to a comprehensive package of program materials to assist in program setup and implementation; including:

    • ICDI Program Manual

    • Goal Setting Handbooks and Health Resources

    • ICDI Orientation and Training Resources

    • Marketing and Recruitment Materials

  • Template press release to announce partnership

  • Awards for program participants

  • Personalized technical assistance to support program set up and implementation


ICDI

ICDI is a mentoring program that uses an individualized approach to encourage regular physical activity and good nutrition for individuals with a disability. ICDI Sites implement the eight-week health promotion program in which mentors are paired with mentees. Mentee-mentor pairs meet at least once a week to set physical activity and healthy eating goals, and to participate in physical activity, sport, recreation, and/or healthy eating activities. Each week, mentors and mentees work together to earn recognition for their efforts by tracking physical activity and healthy eating goals using the Presidential Active Lifestyle Award (PALA+). For more information on ICDI please visit: www.fitness.gov.


PALA+

ICDI uses the Presidential Active Lifestyle Award (PALA+) to recognize participants who complete the program. PALA+ is designed to motivate Americans to make physical activity and healthy eating a part of their daily lives. PALA+ requires participants to set weekly physical activity and healthy eating goals, and to achieve as many as they can. ICDI participants who show measurable progress towards meeting their weekly PALA+ goals and complete the program will earn a PALA+ certificate from the President’s Council on Fitness, Sports & Nutrition. For more information on PALA+ please visit: www.fitness.gov.

Requirements:

    1. Complete the ICDI site application (Pages 2 – 4)

    2. Email the completed application to [email protected].


Next Steps:

Once the completed application is received and approved, a Letter of Understanding will be sent to the primary contact for review, agreement, and signature. The Letter of Understanding will confirm the terms of the partnership.




I Can Do It, You Can Do It! Site Application


Date:


Phone: Fax:


Organization Name: Web site:


Primary Contact Name: Email:


Mailing Address:


Type of Organization:


___ Corporate ___ Education ___ Disability ___ Medical ___ Nonprofit ___ Sports ___ Faith-based

___ Fitness ___ Government ___ Military ___ Nutrition ___ Research/Science ___ Other___________


Term of Agreement: This agreement will automatically renew annually for a one-year term on October 1 of each year. For full details, please review the Letter of Understanding which will be provided to you upon receipt and approval of this site application.


Please describe your organization in 150 words or less, including the mission and chapter locations.

Shape1






What is your organizational goal/commitment to ICDI? How many times a year will your organization run an ICDI program?

Shape2






What activities will you implement to support your ICDI program?

Shape3






How many people do you expect to participate in your ICDI program each year?

Shape4






Do you have existing programs that align with the ICDI program? If so, please list below and briefly describe how they align with ICDI.

Shape5






How do you plan to market your ICDI program to potential participants and partners? What are your marketing reach and goals?

Shape6






Do you anticipate that you will solicit or receive in-kind contributions to support ICDI implementation at your site? If so, who might you receive contributions from?

Shape7






What partner organization(s) do you intend to work with to support your ICDI program?

Shape8






Do you have a presence online or via social media (e.g., website, Facebook, Twitter, Instagram, Snapchat, YouTube, Blog?

Shape9







Do you participate in any events (i.e., national, state or local meetings or conferences) in which you may share information about ICDI? If so, please list below.

Shape10









*Please email a graphic of your organization’s logo (.eps or.ai) with application*


___ I give permission for my organization’s name, description, contact information, logo, URL, widget, success stories, pictures, and/or videos to be used on any PCFSN website. (Please initial)


IMPORTANT MARKETING INFORMATION, PLEASE READ, SIGN, AND DATE


The ICDI logo and materials do not constitute an endorsement of the general policies, activities, or products of (Organization), its partners, or of the information placed on its websites. All uses of the ICDI logo must be approved by the PCFSN prior to being utilized.


The following disclaimer must be included when using the ICDI name or logo online or in print:


(Organization) is an I Can Do It, You Can Do It! Site. Visit www.fitness.gov to learn more.



__________________________________ ____________________

Sign Date


7

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePresident’s Challenge Partnership Program
Authorjwargo
File Modified0000-00-00
File Created2021-01-21

© 2024 OMB.report | Privacy Policy