AFTERSCHOOL EXCELLENCE AWARD - PROGRAM

2010 NOMINATION FORM

An exemplary program site that meets the highest standards of quality in the field and demonstrates capacity to
meet the needs of children, youth and families in their community may be nominated for this award.

PLEASE SUBMIT APPLICATION NO LATER THAN MAY 31, 2010

PROGRAM CONTACT INFORMATION

Agency/Site/Name of Program
___________________________________________ _____________________________________________
Contact Name Title
____________________________________ _________________________________________
Address City/State/Zip
________________________________________ _____________________________________________
Phone E-mail Address
________________________________________________________________________________________

PROGRAM DETAILS
# Years in Operation ________

School Year: Summer Program: (Leave blank if no summer program)

Days Open (check all that apply)
□ Mon. □ Tues. □ Wed. □ Thurs. □ Fri. □ Sat. □ Sun.
Hours of Operation ________________________
Activities Provided (check all that apply)
□ Academic/Tutoring/Homework
□ Arts/Culture
□ Sports/Recreation
□ Community Svc./Workforce development
□ Life skills
□ Other: _________________________________
# Children Served ________
Days Open (check all that apply)
□ Mon. □ Tues. □ Wed. □ Thurs. □ Fri. □ Sat. □ Sun.
Hours of Operation ________________________
Activities Provided (check all that apply)
□ Academic/Tutoring/Homework
□ Arts/Culture
□ Sports/Recreation
□ Community Svc./Workforce development
□ Life skills
□ Other: _________________________________
# Children Served ________

SUBMITTED BY
Name Title
# of Children Served
____________________________________ _________________________________________
_______________
Agency/Site/Name of Program
________________________________________________________________________________________
Address City/State/Zip
________________________________________ _____________________________________________
Phone E-mail Address
________________________________________________________________________________________
Afterschool Excellence Award – Program Award

Individual program sites which have operated for at least two years are eligible for the Program Award. The program
can be public, private, faith-based, based in a school, neighborhood location, or military base. A program director,
supervisor, staff, parent, board member, school administrator or teacher, etc. may submit the application on behalf
of the nominee.

Nominees are exemplary programs that use intentional programming and curriculum to meet the highest standards
of quality in the field, and demonstrate capacity to meet the developmental needs of children, youth and families in
their community.

Please attach a narrative that provides specific examples of how the nominee:

1. utilizes intentional programming and a variety of activities that engage children and youth to develop strong life
skills (5 points)

2. utilizes intentional programming and a variety of activities that develop a child socially, emotionally, physically
and academically (5 points)

3. builds links to and strong relationships with families (5 points)

4. partners with other afterschool and/or community-based organizations (5 points)

5. promotes the professional development of its staff (5 points)

Narratives should include details about specific activities and accomplishments which demonstrate the program’s
contributions to the afterschool community and the children and youth it serves.

You may also include additional letters of support from colleagues, parents and students, as well as copies of relevant
supporting documents, including: pictures, articles or other commendations, or recognition the program has
received.

Supporting documents will not be returned.

PLEASE SUBMIT APPLICATION NO LATER THAN MAY 31, 2010

Completed Nomination Forms & Letters may be mailed, faxed or e-mailed to:

Caitlin King
Program and Outreach Manager
Arizona Center for Afterschool Excellence
112 N Central Ave, Ste 700
Phoenix, AZ 85004

Phone: 602.496.3308 Fax: 602.493.3323

Email: caking@azafterschool.org