Governor's Shape Honor Roll-High 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.

Physical Education Teachers

1. Physical Education teachers are required to assess and enter data for the full battery for 100% of students enrolled in Physical Education classes. Does your school assess and enter full battery data for 100% of students enrolled in Physical Education classes?

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)

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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 question 1 & 2 in addition to question 3.

3. 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 1-3 in addition to questions 4-6.

4. Does your school have an active Wellness Committee?

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.

5. Does your school participate 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.

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

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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 1-6 above in addition to the questions 7.

7. 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.