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SNAP-Ed 2010 Application Sample




       For persons with disabilities, this document is available on request in other formats. To submit a request, please call
                      1-800-525-0127 (TDD/TTY 1-800-833-6388).Washington State Department of Health, Pub. 345-252
Section A. Needs Assessment Methodology and Findings

Needs Assessment Methodology (of your community)

1. Existing Information
   List groups in your community that might be income eligible for SNAP-Ed. List
   the venues where these groups might live, meet, work, shop, and play.
   Indicate possible data and sources to document eligibility and groups’ nutrition and
   health status.

             Group                       Location in My Community                  *Possible

                                     Sunshine Elementary School
                                     Elm Street Intermediate School
Students at school
                                     Morris Schott Middle School             National School Lunch
                                     Wally School High School                Program (NSLP)
                                     Sentinel Tech Alternative School

                                     Merry Sunshine Head Start
                                                                             Head Start and ECEAP
Head Start and ECEAP                 La La ECEAP
                                     Migrant Day Care Center

                                     Lep·re·kon Market                       Census Tract 9814,
Grocery Shoppers
                                     Sunshine IGA                            Block group 4
                                     Estudillos                              59.95% poverty rate
                                     Many walk to grocery stores

Cascade Food Bank                    At the old high school trailer          Local statistics/records
                                     2nd and 4th Saturday 12-3 pm            (< 1 year operation)

Entre Mujeres                        Woman support group-active in           Local stats
                                     teaching classes in English, driving,   Migrant stats
                                     variety of subjects

                                                                             Senior Personal
Paradise Senior Center               Rainbow alley-Paradise
                                                                             Information Form

* See listing on next page. Potential data sources by category.

Potential Data Sources by Eligibility Category

Use these categories to complete the prior page

Category 1 Certified Eligibles
         A. Basic Food Program participants - BFP
         B. Food Distribution Program on Indian Reservations - FDPIR

Category 2 Likely Eligibles as Established by Proxy Criteria
         C. Early Childhood Education and Assistance Program (ECEAP)
         D. Food Banks, Food Pantries and Soup Kitchens
         E. Head Start (HS)
         F. HUD subsidized housing (Section 8 Housing that is income-based)
         G. Medicaid Recipients (130% FPL category)
         H. Personal Information Form (PIF)
         I. Supplemental Security Income (SSI)
         J. Summer Food Service Program (SFSP) – closed enrolled sites
         K. Temporary Assistance to Needy Families (TANF)

Category 3 Potentially Eligible by Site/Location
         L. Census 2000 – people living in census tracts where at least 50% of residents
            have incomes that are = < 185% poverty.
         M. Child & Adult Care Food Program (CACFP)
         N. Food shoppers in grocery stores located in census tracts where at least 50%
            of residents have incomes that are = < 185% poverty.
         O. National School Lunch Program (NSLP)
         P. Special Supplemental Food Program for Women, Infants and Children (WIC)
         Q. Summer Food Service Program (SFSP) – open sites

If you checked Category 3 for any target audience you must complete the Waiver
Request form for that audience. See page 18 in this document for a copy of the form.

Other Audiences Contact your SNAP-Ed contract manager

2. Other Nutrition-related Programs Serving Low-income Persons in your
   community are: (check all those that apply in your community)

     Child and Adult Care Food Program (CACFP)
     The Emergency Food Assistance Program (TEFAP)
     Expanded Food and Nutrition Education Program (EFNEP)
     Food Distribution Program on Indian Reservations (FDPIR)
     Maternity Support Services (MSS)
     National School Lunch Program (NSLP)
     Senior Services
     Special Supplemental Food Program for Women, Infants and Children (WIC)
     Summer Food Service Program (SFSP)
     Washington State University Food $ense Program
     Other: Please specify___________________________________________

3. Describe areas of your community where Basic Food Program eligibles are
   underserved or have not had access to Supplemental Nutrition Assistance
   Program Education previously.

  According to Aging and Adult Care Agency in Rainbow County, there are no subsidized
  food programs for the elderly in this area; neither are there Meals on Wheels. A local
  SNAP-ED program addressed Supplemental Nutrition Assistance Program Education
  with this group last year.

  The majority of people living in Sunshine Alley are foreign-born and have moved here
  since 1990 so would have had little opportunity to have access to Supplemental
  Nutrition Assistance Program Education.

  Sunshine Alley is a rural community without the opportunities of a larger town that might
  have community education classes, Farmer’s Markets, supermarket shopping.

  Over 50% of Food Stamp recipients are children, thereby providing the greatest
  potential for impact on better health. Many live below the poverty level.

  Parents new to the area would be unfamiliar with local resources and available foods for
  feeding their children.

  The local WIC program provides nutrition information and healthy foods to preschool
  children. The Migrant Day Care and Head Start provide nutrition education and healthy
  meals as well.

4. Based on your needs assessment, who is your target audience(s)? Describe why
   you selected them.
   My target audience is Kindergarten and First Graders at the Sunshine Elementary

   Local WIC statistics indicated that over one-third of children receiving WIC in the
   Sunshine Alley area between the ages of 2 and 5 years old, inclusive, have a risk factor
   of BMI greater than the 85th%tile. Nutrition education is needed to reverse the trend of

   As shown in a graph focusing on the years 1986-2001,(and presented by Dr. Roland
   Sturm at the ECOR Conference on the Disparities Between Poverty and Obesity,
   March, 2009), there is a definite correlation between poverty and obesity. More than
   80%of the children in the Sunshine Elementary School qualify for a free or reduced
   lunch, indicating a lower income level. A later comment by Dr. Sturm indicated that
   small stores typically have more processed foods which contain a high concentration of
   kcalories with the potential for excessive weight gain. Healthy food choices are limited.
   Children can learn to find the healthy choices.

   Typically we don’t think of 6 and 7 year olds as having many food choices. At home
   their parents control their food choices. When entering daycare/Head Start they are fed
   and monitored on their intake. WIC provides specific healthy foods for the preschooler.
   Once in school, however, there is much more freedom of choice on what they decide to
   eat from breakfast choices or from their lunch tray. Nutrition lessons can help them
   learn to make the better choice.

   The WIC data on ―low in vegetable‖ intakes show that classes which feature fruits and
   vegetables are appropriate. Most of the kindergartners just graduated from WIC @ 5
   years old so the statistics reflect the average kindergartner entering school.

   Family composition information from the Census 2000 indicated 73.7 households have
   children. Children would be a prime target to learn the nutrition information and then
   impact the family.

   Teaching nutrition in Kindergarten and First-Grade will reach an underserved population
   group as well as having a positive impact on the whole family’s eating pattern. Nutrition
   education is provided for students and parents in WIC and in Head Start. Nutrition is
   studied in upper grade classes. There are many nutrition programs for youth.
   Kindergartners and First -graders are at a prime time for learning to make healthy food
   choices, but no program is aimed directly at them.

   How did you assess the

Needs Assessment Findings (of your target audience)
You may duplicate this section for multiple target audiences.

5. Demographic Characteristics of your Target Audience
   Indicate the source of the data used to describe your Target Audience and their income

          Category                                         Specify
 Sources of Data                    Census 2000
                                    CSO Office Manager
                                    WIC

 Age                             Census 2000. In Rainbow County, 8.7% are under 5
                                 years old; 26.5% of the population is 5-19 years old. In
                                 Sunshine, 12.5% are under the age of 5 years and 31.1%
                                 are 5-19 years old. 43.6% of the population in Sunshine
                                 are children.
 Education                       Census 2000. In Rainbow County, 72.2% have a high
                                 school education with 13.7% carrying a college diploma.
                                 In Sunshine, 19.1% have a high school education and
                                 1.9% carry a college degree.
 Family Composition              In Sunshine, 73.7% of households have children under the
                                 age of 18. And 31.1% of people in Sunshine are ages 5-
                                 19 years, which is school age.
 Gender                          Census 2000. Sunshine consists of 60.3% male and
                                 39.7% female.

 Language(s) Spoken              Census 2000. In Sunshine, English is the only language
                                 spoken in 9.6% of homes. 90% of the homes speak
                                 Spanish with 69.9% speaking English less than very well,
                                 indicating a need for Spanish translation for take-home
                                 materials. No other languages.
 Location (neighborhoods and     The selected area is a rural farming area with localized
 areas where target              housing developments.
 populations reside)
 Race/Ethnicity                  Census 2000. In Rainbow, 79.2% of the residents are of
                                 the White race. 30.1% claim Hispanic (of any race). In
                                 Sunshine, 29.6 claim to be of the White race and 65%
                                 claim ―some other race."

 If available from primary data sources like focus groups, interviews and surveys
 Barriers to accessing food or  There are no authorized Farmer’s Markets within 45 miles.
 physical activity              There are no Supermarkets within 45 miles, although 3
                                local grocery stores serve the area. A Food Bank was
                                established last year and is open twice a month year
                                round. Walking and field work comprise the majority of
                                exercise. The schools have organized sports and Physical

                            Education classes. There is no nutrition program to help
                            parents make wise choices in food shopping and
                            preparation nor is there a group to teach utilization of
                            available foods.
Factors influencing food-   There is a limited choice in grocery shopping for price
related decisions           comparison. It is more difficult to obtain all the nutrients
                            needed within a budget constraint. The program will
                            feature easy, inexpensive food samples.
Other                       Local Sunshine WIC data (two clinics, serving a total of
                            approximately 800 children). 85% of these children have a
                            nutrition risk factor of ―Low vegetable servings.‖ The 5-
                            year old WIC children are graduating into the Elementary
                            school kindergarten, probably with that same risk factor of
                            low vegetables. The nutrition classes will address
                            increasing F&V consumption.

6. Nutrition-related behavioral and lifestyle characteristics of your target audience
   using the information from your needs assessment:
   Include dietary and food purchasing attitudes, habits, as well as where your audiences
   eat, redeem Basic Food benefits, shop, live, learn and play.

   As gleaned from WIC dietary recalls, the majority of families prefer the traditional foods
   of their Mexican heritage. Variety is limited, particularly with vegetables. WIC statistics
   indicate that 85% of the 800 children served by the two WIC clinics in Sunshine Alley,
   have a nutrition risk factor of ―Low vegetable servings.‖ Sweetened beverages and
   desserts are commonly consumed by all age groups.

   All three grocery stores redeem Basic Food benefits and two accept WIC checks. Some
   families travel to a large town once or twice a month for groceries. Locally produced
   fruits and vegetables are eaten in season.

   Housing is typically a small home, mobile home or apartment with basic cooking

   Most meals are home-prepared. There are a couple of restaurants and taco wagons,
   but no fast food chains. The grocery stores and two gas stations also have ready-to-eat
   fried deli foods.

   The town park is a meeting spot for recreational soccer games. Walking around town is
   a common form of exercise.

   There is no community center.

2010 SNAP-Ed Goals, Objectives, Strategies and Collaboration
1. Goal & Objectives – The WA State Department of Health has developed the
   following statewide goal and required objective for all local contractors to
   State Level Goal
   Increase the proportion of Washington State Basic Food Program participants whose
   diets reflect the Dietary Guidelines for Americans and who get at least 30 minutes of
   moderate activity on five or more days a week.
   Local Required Objective: By September 30, 2010 local program participants will
                             increase fruit and vegetable consumption to amounts
                             consistent with current Dietary Guidelines for Americans in
                             an identified SNAP-Ed population.

   The project objective can be based on a factor or consumption. If you have multiple
   target audiences, you are only required to have one fruit and vegetable objective.

   Additional local objectives are optional.

   Local Optional Objective(s):
   Must be an objective focusing on Dietary Quality based on the 2005 Dietary Guidelines:
                                        Eat whole grains every day
                                        Eat fat-free or low-fat milk products every day
                                        Eat Lean meat and beans
                                        Limit fats and oils
                                        MyPyramid-Healthy Eating Plan

      You may incorporate secondary messages into the required or optional objective.
      These messages can not stand alone and must be integrated into the main topics.

   Other Secondary Messages:            Food safety
                                        Food shopping and preparation
                                        Promoting healthy weight
                                        Limit added sugars and caloric sweeteners
                                        Sodium and potassium
                                        Engage in regular physical activity
      An example of incorporating a secondary message is : Include a 10 minute Physical
      activity demonstration in a 60 minute nutrition session.

2. Project Description

   A. Project Planning Template
   For each target audience complete a template with the following information:

   Column 1:       List the key data from your needs assessment
                   Location of the Target Audience (street address, city)
                   Data qualifying the audience as Basic Food Program eligible
                   Source of the data
                   Date of the data (month and year)

   Column 2:       List the eligibility category of your data (see page 2 of this

   Column 3:       Target Audience
                   Indicate the number and age group of the people you plan to reach
                   with your nutrition education activities

   Column 4:       Local Objective
                   Write a S.M.A.R.T. objective that addresses consumption of fruits and
                   vegetables, is relevant to your target audience, and can be measured
                   during the contract year.

   Column 5:       Methods /Approaches
                   Identify and briefly describe the nutrition education approach you will
                   use to influence your target audience behaviors.
                   Indicate your overall methodology, why you chose your particular
                   approach, and why you think it will be effective.

   Column 6:       Nutrition Sessions, Reinforcing Activities, and Timeline
                   List all group sessions specifying the intensity and duration.
                   Be specific on the timeframe, number of group sessions, and series of
                   List all reinforcing activities related activities/events that will help you
                   achieve your objective(s) (i.e. newsletters, bulletin boards, fieldtrips,
                   parent nights etc.)

*Note: you must incorporate a minimum of 3 group sessions of at least 30 minutes
duration each in addition to reinforcing activities. (Current health promotion research
recommends at least six sessions of 30-60minutes duration within a three month period.)


            1                   2          3                     4                           5                                             6
 Needs Assessment           Cate    Target Audience       Local Objective          Methods and Approaches                   Nutrition Education Sessions,
 Data (list location of                                 (outcome-based or                                                 Reinforcing Activities and Timeline
   target audience,                                        factor-based)
 qualifying data, data
  source and date)

                            3       Approximately 125   By September 30,         A series of classroom activity       First Quarter:
                                    Kindergarten and    2010 all students will   based sessions will include          Program planning activities
Sunshine Alley                      First-grade         increase their           puppets, games, crafts, cooking       Parent focus group
Elementary School                   students from 5     preference for fruits    projects, and various hands-on        Staff orientation and training
400 N. Boundary,                    classrooms.         and vegetables by        approaches to familiarize the
Sunshine Alley, WA                                      50%                      students with F&V choices.           Second Quarter:
99349                                                                            Take-home activity calendars          Series of 10 weekly nutrition
                                                                                 and newsletters will reinforce          education sessions of 30-minutes
At Sunshine Alley                                       Secondary                the classroom messages.
Elementary                                              Messages:                Cooperation with the school          Reinforcing Activities
                                                                                                                                   nd rd
School, 82.03% of the                                         Limit added       foodservice personnel to             Will begin 2 -3 quarter
students are eligible for                                 sugars and caloric     promote featured F&V. Colorful        Health Fair for the Kindergarten and
free or reduced price                                     sweeteners             nutrition display boards                 First-grade classes.
lunch.                                                                           throughout the school will
OSPI October 2008                                                                encourage more F&V choices.              Grocery store field trip with parents
                                                                                 A grocery store field trip finale,        and preparation of a recipe to sample
                                                                                 with parents, will summarize the
                                                                                 lessons learned. A subsequent            Parent oriented monthly newsletter
                                                                                 health fair for the Kindergartners       Room displays and cafeteria posters
                                                                                 and first-graders will reinforce          emphasizing current topic.
                                                                                 the preference to choose F&V.
                                                                                                                          Take-home Food Activity Calendars


  B. Summary of Research to support your educational approaches/methods
  Describe the research that supports your educational approach with your target
  audience. Cite specific studies and date where appropriate.

  Discuss how the research studies demonstrate (and to what extent) the feasibility and
  effectiveness of your nutrition education methods.

  According to research, young children learn best by doing and require active thinking
  and experimenting to find out how things work and to learn firsthand about the world in
  which they live. Tasting activities have been a successful method of introducing children
  to a variety of fruits and vegetables that they had never tasted before.

  The greatest gains in health may be made through individual behavior change that is
  supported by families, households, and neighborhoods, institutions such as schools,
  local governments, businesses and voluntary groups. Whole community projects
  actively engage parents and local school districts in an effort to support the healthy
  habits to model for young children.

  Effective classes for children and adults present simple concepts with clear and
  consistent messages are fun and interactive, and food samples will have eye-appeal
  and taste good. Lessons must be presented in a language understood by the audience
  (lots of pictures for young children, and translation to Spanish for the parents.)

  Dr. Alonzo Plough stated at the ECOR Conference on Poverty and Obesity: Disparities
  in Diet and Health (March, 2009), ―Individuals make decisions within the context of the
  surrounding environment.‖ The classroom is an environment. The school is an
  environment. Students will learn as a group to make healthy food choices and influence
  each other, and then their families. There is an individual willingness to try new foods
  when the whole group is taking that action.

  Young children are at the age to educate in making wise choices. According to the
  Kaiser Family Foundation Report, March 2009, children ages two to seven see an
  average of 12 food ads every day, which adds up to more than 4,400 food ads (nearly
  30 hours) of food advertising in a year. Can they discern the healthy foods? Young
  children can be taught to make healthy choices.

  For this project, a series of classroom activity sessions will include puppets, games,
  crafts, cooking projects, and various hands-on approaches to familiarize the students
  with F&V choices. Take-home activity calendars and newsletters will reinforce the
  classroom messages in addition to the school foodservice personnel who will promote
  featured F&V throughout the school with nutrition display boards.

  A grocery store field trip finale, with parents, will summarize the lessons learned. A
  subsequent health fair for the Kindergartners and first-graders will reinforce the
  preference to choose F&V.

As children enter kindergarten for the first time, parents report about 92 percent seem
eager to learn and report that about two-thirds to three-quarters of beginning
kindergartners ―often to very often‖ persist at tasks, seem eager to learn, and are able to
pay attention.
America's Kindergartners: Findings from the Early Childhood Longitudinal Study,
Kindergarten Class of 1998-99: Fall 1998.

Kindergarten and first-graders typically have an attention span of 20-30 minutes. The
proposed lessons will be within that time frame.

The Wally School District has written and implemented a Nutrition and Physical Activity
plan following the CDC Obesity Prevention Project guidelines. Controlling access to
unhealthy foods is a good foundation. Teaching about healthy nutrition choices to help
control the obesity epidemic is a good next step. The proposed lessons will enhance
and not supplant the Wally School District’s plan.

C. Use of Existing Educational Materials/Curricula Use
Complete the table for materials you plan to use. You may duplicate the table if more space is required.
You must use materials that are scientifically based and have been updated for the 2005 Dietary Guidelines.
You may not use materials containing the old Food Guide Pyramid or materials from Produce for Better Health 5 a Day campaign.

                Title                    Language(s)            Cost           Target                        Description
               Author                                                         Audience         Provide a brief description of the content
               Source                                                                               focusing on the key messages

                                         English and      Printing            Grades 1-       Lesson 1. Exploring My Pyramid for Kids
Lessons 1-3 are from My Pyramid          some                                 2                introduces the food groups that make up My
for Kids Team Nutrition Program          Spanish                                               Pyramid for kids. An added emphasis will
available from the Food and Nutrition                                                          then focus on the Fruits and Vegetables
Service of the USDA.                                                                           Group. Extra activity will be a mystery food
Downloadable from                                                                              game.                                                         Lesson 2. Eat Smart with My Pyramid for
es/mypyramidclassroom.html                                                                     Kids features making food choices for
                                                                                               Healthy Eating. Children learn to categorize
                                                                                               foods into the proper food groups. They will
                                                                                               learn to recognize a variety of fruits and
                                                                                               vegetables by name with corresponding
                                                                                               samples. Added activity will be a Fruit and
                                                                                               Veggies placemat.
                                                                                              Lesson 3. Vary Your Veggies and Focus on
                                                                                               Fruits includes completing a diary of foods.
                                                                                               An added feature will be creating a booklet
                                                                                               identifying fruits and vegetables as a
                                                                                               rainbow of colors.

Lessons 4-7 are adapted from Neat        English and      Cost of printing    K-1          The lessons used will focus on particular fruits
Solutions                                Spanish                                           and vegetables.
lessons.htm                                                                                   Lesson 4 Enjoying Carrots focuses on
                                                                                               carrots and beta-carotene. Adding activities
                                                                                               about root vegetables.
                                                                                              Lesson 5 from Seeds to Salad Bars
                                                                                               includes information about heart health,
                                                                                 cancer prevention, and fiber. Add an
                                                                                 activity of a Fruit and Vegetable Scavenger
                                                                                Lesson 6 Amazing Pumpkins features
                                                                                 measurement activities. Will make pumpkin
                                                                                 pie in an orange.
                                                                                Lesson 7 Vegetable Party reinforces the
                                                                                 recommended amounts of fruits and
                                                                                 vegetables to eat each day and identifies
                                                                                 the edible portions of plants.

Lessons 8-10 are from Super Star          English   Cost of printing   K-2      Lessons are 30 minutes and include an
Nutrition for Kids developed by the                                              Overview, Key message, Objective and
Oregon Department of Education.                                                  materials needed in the Trainer Summary
Lessons are downloadable from                                                    Information. Actual lessons include an                                          activity, nutritional lesson, cooking activity
lesson_plans.aspx                                                                and lesson reinforcer. Children learn to
                                                                                 incorporate fruits and vegetables into their
                                                                                 daily meals.
                                                                                Lesson 8 Nutrition Basics for Super Star
                                                                                 Menus will teach planning menus
                                                                                 incorporating fruits and vegetables.
                                                                                 Attention given to vitamins in fruits and
                                                                                 vegetables. Activities including making fruit
                                                                                 and vegetable collages from newspaper
                                                                                 store advertisements.
                                                                                Lesson 9 Cooking Super Star Meals with
                                                                                 Kids includes supervised preparation of
                                                                                 recipes featuring fruits and vegetables
                                                                                 which helps children appreciate healthy
                                                                                 food choices as they learn about how fruits
                                                                                 and vegetables look, smell, feel, sound, and
                                                                                Lesson 10 Shopping for Super Star Menus
                                                                                 helps children identify seasonal fruits and
                                                                                 vegetables, and different forms of fruits and
                                                                                 vegetables including canned and dried. A
                                                            shopping trip is done with the parents.

These programs will be supplemented
with Arts & Crafts, Food Games,
Science Experiments, and Songs from
the Food Groupies as well as the
University of Illinois Extension
Wellnessways website at, a
Family Nutrition Program funded with
Food Stamp Administrative funds.

 Fruits and Veggies, More Matters!:    Estimated cost for
http://www.fruitsandveggiesmorematte   pamphlets,                                 brochures and
                                       posters from this
                                       site is $150.

Nasco Nutrition Teaching Aids.         $60
Fruit and veggie models, My Pyramid
pocket chart, to support the program

Neat Solutions.                        $100.00
Puppets, Model Fruit and Vegetable

D. Modification of Project Methods
Describe adaptations and modifications you will make to your education methods/approach and curriculum (listed above) to achieve
your objective(s).

                   Curriculum Title                                Adaptation/Modification                        Justification
                                                            The school aides and the assistant for       Since Sunshine Alley is an
Team Nutrition Program and SuperStart Nutrition for        this SNAP-ED project will translate           area of a large number of
Kids.                                                      materials going home to the parents.          Spanish speaking individuals.

Lessons 4-7 are adapted from Neat Solutions                                                              Gardening is not SNAP-ED              Only specific food lessons will be used
                                                              from Neat Solutions—no gardening

Lessons 8-10 are from Super Star Nutrition for Kids           The lessons on Food Safety and Fun         The lesson is not SNAP-ED
developed by the Oregon Department of Education.              with Physical Activities from the Super    appropriate
Lessons are downloadable from                                 Star Nutrition for Kids program will not      be used.

E. Development of New Educational Materials:
Identify any new materials that you plan to produce or purchase and justify the need and


3. Evaluation Plans: For each target audience objective, complete an Evaluation
   Template (ET)

   Target Audience:       Fill in information from column 3 of your planning template

   Objective:             Fill in information from column 4 of your planning template

   If the project has been previously evaluated, list the date and a brief description
   of the results.

   Column 1.       Activities:
                   Fill in the activities that support your objective from column 6 of your
                   planning template.

   Column 2.       Measures:
                   Identify from your objective the change you want to measure and the
                   amount of change you expect to happen.

   Column 3. A.    Methods/Tools:
                   Describe what methods and tools you will use to measure change in
                   factors or consumption.

   Column 3. B.    Data Collection:
                   Indicate how and when you will collect data from your participants.

   Column 3. C.    Analysis:
                   What is your plan for reviewing and analyzing your results? How will
                   you use your evaluation data and information?

                  1                               2                                                  3
Activities that support objective     What will be measured?                            How will we measure?
    From planning template
          Column 6                     Changes in factors like              Methods and Tools used to measure change(s)
                                      knowledge, skill, attitude
                                          or consumption
                                                                            A                         B                      C
                                                                     Methods and Tools          Data Collection      Analyzing Your
First Quarter:
Program planning activities          Change in F&V Preferences     Formative Methods and       Formative will        The SNAP-Ed
 Parent focus group                 by 50%.                       tools                       occur during the      Coordinator will
 Staff orientation and training
                                                                    Staff input on methods    first quarter.        complete analysis of
                                                                      and messages for         SNAP-Ed               data after each
Second Quarter:
                                                                      students and parents     assistant will        session.
 Series of 10 weekly nutrition
                                                                      during training and      record notes from     Results will be
   education sessions of 30-
   minutes                                                            orientation.             discussion.           shared with staff and
                                                                    Focus group to assess                           teachers at regular
Reinforcing Activities                                                parents on their                               meetings for
            nd rd
Will begin 2 -3 quarter                                               current understanding                          discussion of
 Health Fair for the Kindergarten                                    of F&V and willingness                         successes and
    and First-grade classes.                                          to change.                                     recommended
                                                                                               After each            changes for the next
   Grocery store field trip with                                  Progress tools and          nutrition education   interventions.
    parents and preparation of a                                   methods
    recipe to sample                                                                           session, data will
                                                                    # of posters/bulletin     be collected by
   Parent oriented monthly                                           boards displayed         SNAP-Ed
    newsletter                                                      # of newsletters sent     assistant and
   Room displays and cafeteria
                                                                      home                     analyzed and
    posters emphasizing current                                     # students who try        summarized by
    topic.                                                            demonstrated food        the nutrition
   Take-home Food Activity                                        Outcome Tools and
    Calendars                                                      Methods
                                                                   Pre and Post Program
                                                                   Food Preference Survey
                                                                   for Children (Cullen)

4. Coordination Efforts
   Put a check by the partner agency/program that you will collaborate with in order to
   deliver consistent behavior-focused messages.
   Submit a signed partnership agreement to document what each partner agency
   and/or program will do to contribute to your nutrition education project.
   If partnering with WIC or Head Start you must describe how your SNAP-Ed nutrition
   education activities will enhance, not supplant existing requirements. If partnering
   with a school, you must describe how your SNAP-Ed activities enhance, not
   supplant nutrition education requirements of the school districts’ wellness policy.

  Agency on Aging
  After School Snack Program
  Basic Food Program (BFP)
  Boys and Girls Club
  Child and Adult Care Food Program
  Early Childhood Education & Assistance Program
  Farmers Market
  Head Start
  National School Lunch Program
  Parks and Recreation
  School Breakfast Program
  Summer Food Service Program
  The Emergency Food Assistance
  Program (TEFAP)
  Other: (Specify)
  Sunshine Alley Elementary School                           X

ASSURANCES: To assure compliance with policies described in this guidance, the Supplemental
Nutrition Assistance Program Education plan must include the following assurances. Mark your response
to the right.
 To assure compliance with policies described in this guidance, the Supplemental Nutrition           Yes   No
 Assistance Program Education Plan must include the following checklist of assurances that:
 1. The contractor is accountable for the content of the nutrition education plan and provides
      oversight to any sub-grantees. The contractor is fiscally responsible for nutrition education  X
      activities funded with Basic Food funds and is liable for repayment of unallowable costs.

 2. Efforts have been made to target nutrition education to BFP participants and eligibles.            X

 3. In cases where Food Stamp Nutrition Education projects may inadvertently benefit persons that      X
    are ineligible for the Basic Food Program because it is not practical or possible to meet the
    exclusivity requirement, the local agency has submitted waiver requests for each project. To be
    approved the waiver request(s) must clearly demonstrates how the proposed project provides a
    good means of reaching food stamp eligibles and documents that at least 50 percent of those
    reached will have gross incomes at or below 185 percent of the poverty thresholds or guidelines.

 4. Only expanded or additional coverage of those activities funded under the Expanded Food and        X
    Nutrition Education Program (EFNEP) may be claimed under this application. Approved activities
    are those designed to expand the State's current EFNEP coverage in order to serve additional
    BFP eligibles or to provide additional education services to EFNEP clients who are eligible for
    the Basic Food Program. In no case may activities funded under the EFNEP grant be included in
    the budget for SNAP-Ed.

 5. Cash or in-kind donations from other non-Federal sources to Food Stamp Nutrition Education         X
    have not been claimed or used as a match or reimbursement under any other Federal Program.

 6. Costs incurred by other state and/or local agencies for goods and services for SNAP-Ed and         X
    which are then donated to DSHS make up the public in-kind contributions that are included in the
    State share of costs that are eligible for Federal Reimbursement. They cannot be used as a
    match under any other federally funded project.

 7. Documentation of local agency costs, payments and donations for approved activities are            X
    maintained by the State and will be available for USDA and DOH review and audit.

 8. Contracts are procured through competitive bid procedures governed by the State procurement        X

 9. Program activities are conducted in compliance with all applicable Federal laws, rules,            X
    regulations including Civil Rights and OMB circulars governing cost issues.

 10. Program activities do not supplant existing education program, and where operating in             X
     conjunction with existing programs, enhance and supplement them.

 11. Program activities are reasonable and necessary to accomplish BFP nutrition education             X

 12. All materials developed or printed with Food Stamp Nutrition Education funds include the          X
     appropriate USDA non-discrimination statement, credit to the Food Stamp Program as a funding
     source, and a brief message about how the Food Stamp Program can help provide a healthy diet
     and how to apply for benefits.
 13. Messages of nutrition education are consistent with the Dietary Guidelines for Americans and      X
     stress the importance of variety, balance, and moderation, and do not disparage any specific
     food, beverage, or commodity.

Waiver Request ONLY for Category 3 Target Audiences– Potentially Eligible by

   a. Agency/Organization Name:
      Sunshine Alley Elementary School

   b. Local Project Objective:
    By September 30, 2010, all students will increase their preference for fruits and
   vegetables by 50%.

   c. Narrative justification for need for waiver:
      Although the majority of students in Kindergarten and First Grade at Sunshine
      Alley Elementary School are in an area of eligible BFP participants and 82% are
      eligible for a free or reduced lunch, it is not practical to separate out the audience
      when an activity lesson is conducted.

   d. Description of low-income population intended to be reached that are not
      the project’s target population (Basic Food Program applicants and

      1. Location of project:
         Sunshine Alley Elementary School
         400 North Boundary
         Sunshine, WA 99349

      2. Demographic and census data documentation that demonstrates that at
         least half of this target population is at or below 185 percent of poverty:

          a. Data source
             Fee and reduced price meal applications in schools, OSPI

          b. Data
          School data: 82.03% of students are eligible for free and reduced lunch.

          c. Date of data collection (month and year)
             OSPI October 2008


                    BASIC FOOD PROGRAM

                       Fiscal Year 2010

             Annual Plan for Nutrition Education


                     DATE: APRIL 30, 2009

                         Certified By:

AUTHORIZING SIGNATURE                           DATE




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