Apply for ReCharge!

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ReCharge! Energizing After-School is a fun-for-kids program designed for students in grades 2 to 6 to learn about and practice good nutrition and physical activity habits. A collaboration with the National Football League, ReCharge! is a complete, easy-to-use kit with lesson plans, equipment, information for families and much more.

Learn more today to make the most of ReCharge! with your students!

Apply for ReCharge!

ReCharge! Energizing After-School is full of fun and active games for students to keep them energized to learn about eating a healthy diet and living an active lifestyle. Because of its benefits and the generous support of the National Football League through their Play 60 initiative, Action for Healthy Kids is pleased to supply kits at NO COST.

Schools, community-based organizations and others can apply to receive a kit below. Please complete all the information requested. Action for Healthy Kids reserves the right to fulfill all or part of a request, based on need and the number of applications received. Requests for more than 10 kits will be contacted for more information.

NOTE: You must answer every single question in this application to submit successfully. After you submit, you should receive a Thank You page and an email confirmation stating your submission was successful. If you do not receive these, please try to submit again.

Contact Information. NOTE: No PO Boxes.

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Yes, I would like to receive e-mail from Action for Healthy Kids.

Remember me. What's this?

Question - Required - School/Organization

Question - Required - Please indicate the total number of kits you are requesting. NOTE: One kit will meet the needs of ~50 students.

Question - Required - Will you, the applicant, implement the ReCharge! program?

Question - Required - Please indicate the total number of school buildings or locations where ReCharge will be implemented.

Question - Required - Please indicate the type of program requesting the ReCharge! kit. Check all that apply.

	After-school program (school-based)
	After-school program (community-based)
	School district
	Summer day camp
	Daycare facility (in-home or other)
	In-class activities during school
	Community service/Non-profit organization
	State/Government agency

Question - Not Required - Please specify if not listed above.

Question - Required - Please indicate the total number of students enrolled in your site's program

Question - Required - Please indicate the number of students grades 2nd through 6th enrolled in your site's program

Please indicate ethnicity of students enrolled in this program. Please enter by percentage.

Question - Required - African American

Question - Required - Hispanic

Question - Required - Caucasian

Question - Required - Asian

Question - Required - American Indian/Alaskan Native

Please indicate the percentage of students in this program receiving free- or reduced-price lunch.

Question - Required - Free

Question - Required - Reduced

Question - Required - Please describe how you will be using the ReCharge! program. If you don't work for a school, please indicate how this program will benefit schools in your area. Please be as complete and thorough as possible.

Question - Required - I agree to participate in efforts to evaluate the ReCharge! curriculum (i.e., user surveys, pre/post student surveys).

Question - Required - Would you be interested in receiving monthly or quarterly ReCharge! e-newsletters that share program successes from across the country?

Question - Required - Would you be interested in sharing your successes with ReCharge, including in Action for Healthy Kids communications?

How did you hear about the ReCharge!?

(Select one of the available choices or enter a different value.)
Question - Required -

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