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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 ________
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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: [email protected]