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Request for Qualifications – Healthy Schools RFQ - County of Sonoma

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Statement <strong>of</strong> <strong>Qualifications</strong> Survey<br />

Attachment A<br />

Please answer the following questions, submitting one survey per school <strong>for</strong> which you<br />

are submitting a proposal. Your responses will provide the review committee with<br />

in<strong>for</strong>mation on your school’s capacity and interest in implementing components <strong>of</strong> the<br />

identified program(s). Submit the completed survey with your application.<br />

1. What is the name and address <strong>of</strong> the school <strong>for</strong> which you are submitting a proposal?<br />

__________________________________________________________________<br />

2. How many students are currently enrolled at the school?<br />

____________________<br />

3. How many Latino/Hispanic students are currently enrolled at the school?<br />

____________________<br />

4. How many students are eligible <strong>for</strong> the Federal Free and Reduced Priced Meal<br />

Program? ____________________<br />

5. Is your school currently participating in programs aimed at increasing physical<br />

activity, decreasing calorie consumption, or increasing fruit and vegetable<br />

consumption among school-aged children and perhaps their families?<br />

The HEAL Zone Project<br />

<strong>Healthy</strong> <strong>for</strong> Life<br />

Network <strong>for</strong> a <strong>Healthy</strong> Cali<strong>for</strong>nia<br />

Safe Routes to School<br />

Other: _____________________________________________________<br />

Rev. Oct. 2011 Page 9 <strong>of</strong> 73

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