Governor's Shape Honor Roll-Middle School Application

School Name and District (required)

School Address (required)

Grades Served (required)

Contact Person (name, title, phone and email) (required)

Questions 1 & 2 qualify schools for the Bronze Honor Roll distinction.

1. Physical Education teachers must assess and enter data for the full battery for 50% of students in each grade. Does your school assess and enter full battery data for at least 50% of students in each grade?

Yes, see documentation

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

2. Please provide a verification statement signed by the principal and lead physical education teacher verifying all submitted information is correct. (required)

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

Schools applying for Silver Level distinction must answer questions 1-2 in addition to questions 3-4.

3. Physical Education teachers must assess and enter data for the full battery for at least 75% of students in each grade. Does your school assess and enter full battery data for at least 75% of students in each grade?

Yes, see documentation

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

4. Does your school offer regularly scheduled, additional supervised fitness-related activity? This does NOT include interscholastic competitive sports.

Yes, see documentation

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

Schools applying for Gold Level distinction must answer questions 1-4 in addition to questions 5-7.

5. Does your school have an active Wellness Committee?

Yes, please provide the roster and an example of one accomplishment

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

6. Does your school participate in the Healthier US School Challenge or the Alliance for a Healthier Generation School Program?

Yes, provide documentation

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

7. Please submit a ONE page “Healthy School” success story.

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.

Schools applying for the Platinum Honor Roll distinction must answer questions 1-7 above in addition to the question 8.

8. Did your school earn an award status in the Healthier US School Challenge or the Alliance for a Healthier Generation School Program?

Yes, see documentation

No

First select 'choose file' to locate file and then select 'upload' to attach to your application.
One file only.
2 MB limit.
Allowed types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, ppt, pptx.