DOCUMENT #6

PLANNING AND RECORD FORM

Youth Engagement Examples Established, Planned or Considered
For the Food and Fitness Initiative

Long Version - Draft for Review

PURPOSE OF FORM:
 To provide key questions that facilitate well-informed consideration, planning and
implementation of youth engagement strategies/examples at each site.
 To provide a framework to record and share key information about youth engagement
examples among members of each collaborative and across sites
 To provide a framework to record and share key information with technical assistance
providers and W.K. Kellogg that will help shape their support for youth engagement.

DIRECTIONS:
1. Provide contact person information below
2. Consult Index and record youth engagement type(s) on next page
3. Record brief description of specific example on next page
4. Preview questions, then record answers.
5. Submit form to your site’s youth engagement point person or post on site

YOUTH ENGAGEMENT TYPE INDEX:

a. Research or Assessments
b. Planning Processes
c. Educators
d. Spokespersons
e. Governance and Leadership Positions
f. Social Capital or Coalition Building
g. Program Develop or Implement
h. Media and Communications
i. Grant Making and Philanthropy
j. Policy Formulation or Promulgation
k. Local, State or National Advocacy
l. Evaluation Design or Conduct
m. Economic Empowerment
n. Cultural Competency Development
o. Youth-Adult Partnership Development
p. Built Environment Related
q. Food System Related
r. Safe Places to Play
s. Creating Vibrant Communities
t. Change System or Practice
u. Event Planning
v. School-based activity.
w. Workplace-based activity
x. Other

CONTACT PERSON:

Name: ______________________________________________________________________________

Organization/Department: ______________________________________________________________

Address: ____________________________________________________________________________

City-State-Zip: _______________________________________________________________________

Phone: ______________________________________Fax: ___________________________________

E-Mail: _____________________________________________________________________________
PROPOSED WORKSHEET FORM INFORMATION

Food and Fitness Site: ________________________________________________________

Type(s) of Youth Engagement Example Exhibits (See Index):

Brief Description of Specific Youth Engagement Example:

Status of Example:
 This example is established
 This example is in our plans
 We are considering this example

Implementation Priority:
 High Priority
 Medium-Term Goal
 Longer Term Goal

Our Readiness to Implement this Example:

 We have sufficient local expertise and resources
 We have the necessary local expertise and resources to get started, but we could
benefit from additional support
 We are starting from scratch and welcome any help from others

PROPOSED QUESTIONS:

1. AGE…What is the likely age range of the youth?

2. NUMBERS…How many youth are expected to participate?

3. SOURCE…Source of the youth who will be engaged? How will they be recruited?

4. AUDIENCE…What is the target audience or environment of this youth effort?

5. ACTIVITIES…What things will the youth do?

6. FAF GOALS… What Food and Fitness goals will this example help achieve?

7. OTHER GOALS…What other important goals will this example help achieve?

8. PLACE AND FREQUENCY…When, where and how often will this occur?

9. HOST ORGANIZATION…What organizations will provide lead support?

10. SUPPORT FOR SUCCESS…What will these youth need to succeed?

11. RESOURCES…What resources will initiate this youth engagement? Their allocation?

12. SUSTAIN AND EXPAND…Strategies or resources to sustain or expand?

13. SUCCESS…How will you measure success?

14. SUPPORT YOU’LL NEED…What help do you need from peers or the YEA?

15. OTHER – [_____________________________________________________________]

16. OTHER – [_____________________________________________________________]