8/9/2019 Afterschool Award Nomination Form - Program 2010

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AFTERSCHOOL EXCELLENCE AWARD - PROGRAM

2010 NOMINATION FORM

An exemplary program site that meets the highest standards of quality in the field and demonstrates capacity tomeet the needs of children, youth and families in their community may be nominated for this award.

PLEASE SUBMIT APPLICATION NO LATER THAN MAY 31, 2010

PROGRAM CONTACT INFORMATION

Agency/Site/Name of Program

___________________________________________ _____________________________________________

Contact Name Title

____________________________________ _________________________________________Address City/State/Zip

________________________________________ _____________________________________________

Phone E-mail Address

________________________________________________________________________________________

SUBMITTED BY

Name Title

____________________________________ _________________________________________

Agency/Site/Name of Program

________________________________________________________________________________________

Address City/State/Zip

________________________________________ _____________________________________________

Phone E-mail Address

________________________________________________________________________________________

PROGRAM DETAILS

# Years in Operation ________

School Year: Summer Program: (Leave blank if no summer program)

Days Open (check all that apply) Days Open (check all that apply) Mon. Tues. Wed. Thurs. Fri. Sat. Sun. Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Hours of Operation ________________________ Hours of Operation ________________________

Activities Provided (check all that apply) Activities Provided (check all that apply)

Academic/Tutoring/Homework Academic/Tutoring/Homework

Arts/Culture Arts/Culture

Sports/Recreation Sports/Recreation

Community Svc./Workforce development Community Svc./Workforce development

Life skills Life skills

Other: _________________________________ Other: _________________________________

# Children Served ________ # Children Served ________

8/9/2019 Afterschool Award Nomination Form - Program 2010

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Afterschool Excellence AwardProgram Award

Individual program sites which have operated for at least two years are eligible for the Program Award. The program

can be public, private, faith-based, based in a school, neighborhood location, or military base. A program director,

supervisor, staff, parent, board member, school administrator or teacher, etc. may submit the application on behalf

of the nominee.

Nominees are exemplary programs that use intentional programming and curriculum to meet the highest standards

of quality in the field, and demonstrate capacity to meet the developmental needs of children, youth and families in

their community.

Please attach a narrative that provides specific examples of how the nominee:

1. utilizes intentional programming and a variety of activities that engage children and youth to develop strong lifskills (5 points)

2. utilizes intentional programming and a variety of activities that develop a child socially, emotionally, physicallyand academically (5 points)

3. builds links to and strong relationships with families (5 points)4. partners with other afterschool and/or community-based organizations (5 points)5. promotes the professional development of its staff (5 points)

Narratives should include details about specific activities and accomplishments which demonstrate the programs

contributions to the afterschool community and the children and youth it serves.

You may also include additional letters of support from colleagues, parents and students, as well as copies of relevantsupporting documents, including: pictures, articles or other commendations, or recognition the program has

received.

Supporting documents will not be returned.

PLEASE SUBMIT APPLICATION NO LATER THAN MAY 31, 2010

Completed Nomination Forms & Letters may be mailed, faxed or e-mailed to:

Caitlin King

Program and Outreach ManagerArizona Center for Afterschool Excellence

112 N Central Ave, Ste 700

Phoenix, AZ 85004

Phone: 602.496.3308 Fax: 602.493.3323

Email: caking@azafterschool.org