Candidate Application – Ginn Group Collaborative

School/District Candidate Application
for SMART Student Health and Wellness Center Implementation

Thank you for your interest in bringing SMART to your district.

Please fill out this SMART Model School Application, so we can learn more about your district and how you learned about SMART. After your application is submitted a member of our team will follow up with you within 2–3 business days with more information on the Model.

District Information
Name of School District (and specific schools, if applicable):*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Key contact/liaison name and title:*
Contact/liaison email*
Contact/liaison phone number*
Name of superintendent and/or principal:*
Size of district and/or school and grades served:*
Number of teachers within the district and/or schools:*
Dollars spent per student:*
Dollars spent per student for health and wellness:*
Percentage of students receiving free/reduced lunch:*
Current academic ranking within district or state:*
What electronic records system does district use?*
How many school nurses does your district employee?*
How are your school nurses allocated within the district?*
Do your school nurses belong to a union?*
Student Demographics
Please provide your districts demographic information. Include race, ethnicity, gender, and multilingual learner breakdown.*
How many IEP/504 students does your district serve?*
Applications Questions
What are the biggest challenges facing your district/students?*
Please tell us how you learned about the SMART Model and how you hope it can support better academic and health outcomes for your students and schools:*
Please describe, in detail, the current health services being provided (include by whom they are provided, the number or percentage of students receiving care, and outcomes):*
Please explain whether those services or the personnel providing them are full-time, part-time, or shared between schools, and whom within the district/school monitors the service:*
If selected for the SMART Model, who has the authority to implement it at the school, district, and/or board level? Who are the key stakeholders, and is there a formal decision-making process?*
If selected, what barriers or challenges do you anticipate will need to be to overcome for the success of the SMART Model?*

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School/District Candidate Application for SMART Student Health and Wellness Center Implementation

District Information

Student Demographics

Applications Questions

School/District Candidate Application
for SMART Student Health and Wellness Center Implementation