2020-2021 SWITCH Registration

2020-2021 SWITCH Registration
Are you a new or returning school to SWITCH? *

New, this will be our first year! Returning, we are back for another year!
Name of School *
County *
School Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Building Level *

Elementary School (grades 4-5) Middle School (grades 6-8) Both (combination of grades across both levels)

Indicate which grades will be participating and how many classrooms from each respective grade level. (Best practice recommends all classrooms in the grade level participate together.) *

Participating

Total # of Classrooms

# of Classrooms Participating in SWITCH

4th

5th

6th

7th

8th

School Administrator Contact (principal of school building, superintendent, etc.) *

First Name Last Name
Email *
example@example.com

School Core Team Member Information: (List your main school team contact as the Core Team Leader. It is recommended to have at least 3 team members from various settings in the school. It is okay if you don't have them all confirmed yet, but please list those that you have identified.) *

First Name

Last Name

Role in School

Core Team Leader

Team Member #2

Team Member #3

Team Member #4

Team Member #5

Team Member #6

If there are additional team members, please put their information here:
There are a variety of SWITCH program offerings your school can opt into this year that will provide additional opportunities. Please select those that you'd be interested in and would like to be contacted with more information.

SWITCH Youth Ambassador Team: Engaging student leaders to introduce healthy habit activities with their peers. Heart Health Lessons: The Iowa Heart Center Foundation is offering lessons about maintaining a healthy heart and will offer additional resources to schools interested in participating, including the chance to win an AED for your school. Mindfulness: Classroom resources to learn about mental health and practice mindful moments during school day.
School Core Team Members will be contacted by the SWITCH team to receive updates on training opportunities and resources for SWITCH. This communication will also include receiving our quarterly newsletter that shares important updates and outcomes of schools involved in SWITCH.
I agree for our school core team members emails to be added to the SWITCH contact list to receive routine updates and information to help us in implementing SWITCH at our school, including the quarterly newsletter. Recipients can unsubscribe from the newsletter at any time. *

Yes, we agree to receive the quarterly newsletter. No, we do not want to receive quarterly newsletter.
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