School Name and District (required) School Address (required) Grades Served (required) Contact Person (name, title, phone, and email) (required) Questions 1-4 qualify schools for the Bronze Honor Roll distinction 1. All students in grades K-5 are required to have at least 90 hours of health and physical education instruction. Do all students in grades K-5 meet these requirements? 1. All students in grades K-5 are required to have at least 90 hours of health and physical education instruction. Do all students in grades K-5 meet these requirements? (required) Yes, see documentation No 1. File 1. File (required) First select "choose file" to locate file and then select "upload" to attach to your application. 2. Physical Education teachers are required to assess and enter data for 100% of students in grades 4-5 for the full battery. Did your school enter the required data for 100% of the 4th & 5th grade students? 2. Physical Education teachers are required to assess and enter data for 100% of students in grades 4-5 for the full battery. Did your school enter the required data for 100% of the 4th & 5th grade students? (required) Yes, see documentation No 2. File 2. File (required) First select "choose file" to locate file and then select "upload" to attach to your application. 3. Physical Education teachers are required to assess and enter height and weight data for 100% of students in grades 1-3. Did your school enter the required data for 100% of the 1st-3rd grade students? 3. Physical Education teachers are required to assess and enter height and weight data for 100% of students in grades 1-3. Did your school enter the required data for 100% of the 1st-3rd grade students? (required) Yes, see documentation No 3. File 3. File (required) First select "choose file" to locate file and then select "upload" to attach to your application. 4. Please provide a verification statement signed by the principal and lead physical education teacher verifying all submitted information is correct. 4. 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. Schools applying for the Silver Honor Roll distinction must answer questions 1-4 above in addition to question 5. 5. Does your school schedule and implement weekly recess and or physical activity time for all students in grades K-5? 5. Does your school schedule and implement weekly recess and or physical activity time for all students in grades K-5? Yes, see documentation No 5. File 5. File First select "choose file" to locate file and then select "upload" to attach to your application. Schools applying for the Gold Honor Roll distinction must answer questions 1-5 above in addition to the questions 6-10. 6. Does your school have an active Wellness Committee? 6. Does your school have an active Wellness Committee? Yes, see documentation No 6. File 6. File First select "choose file" to locate file and then select "upload" to attach to your application. 7. Does your school schedule and implement daily recess or physical activity time for all students in grades K-5? 7. Does your school schedule and implement daily recess or physical activity time for all students in grades K-5? Yes, see documentation No 7. File 7. File First select "choose file" to locate file and then select "upload" to attach to your application. 8. Does your school participate in the Healthier US School Challenge or the Alliance for a Healthier Generation School Program? 8. Does your school participate in the Healthier US School Challenge or the Alliance for a Healthier Generation School Program? Yes, see documentation No 8. File 8. File First select "choose file" to locate file and then select "upload" to attach to your application. 9. Has your school signed the “Power Up for 30” Pledge? 9. Has your school signed the “Power Up for 30” Pledge? Yes, see documentation No 9. File 9. File First select "choose file" to locate file and then select "upload" to attach to your application. 10. Please submit a ONE page “Healthy School” success story 10. 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. Schools applying for the Platinum Honor Roll distinction must answer questions 1-10 above in addition to the questions 11-12. 11. Did three representatives from your school attend a Power Up for 30 training? 11. Did three representatives from your school attend a Power Up for 30 training? Yes, please provide the date, location, and who attended No 11. File 11. File First select "choose file" to locate file and then select "upload" to attach to your application. 12. Please submit a ONE page “Power Up for 30” success story 12. Please submit a ONE page “Power Up for 30” success story First select "choose file" to locate file and then select "upload" to attach to your application. CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.