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Governor's Shape Honor Roll-Elementary School Application

 

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. File
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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. File
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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. File
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4. Please provide a verification statement signed by the principal and lead physical education teacher verifying all submitted information is correct.
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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. File
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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. File
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7. Does your school schedule and implement daily recess or physical activity time for all students in grades K-5?
7. File
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8. Does your school participate in the Healthier US School Challenge or the Alliance for a Healthier Generation School Program?
8. File
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9. Has your school signed the “Power Up for 30” Pledge?
9. File
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10. Please submit a ONE page “Healthy School” success story
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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. File
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12. Please submit a ONE page “Power Up for 30” success story
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