1. Name of School District: 

2. Name of your school: 

3. Number of students in your building 

4. Is PE required for all students K – 12 every year?  Yes or No 

4b. Explain any exemptions: 

5. Are there particular grades in your school where PE is NOT required? Yes or No

5b. If yes, which grades?  

6. Number of PE teachers in your building or who serve your building: (For example, a school with one full-time PE teacher and one who only taught PE half time would have 1.5 teachers.)  

7. Average number of students in PE classes:   0-10 11-20 21-30 more than 30

8. How often do students attend physical education classes in your school?  once a week twice a week three times a week four times a week five times a week one term one semester all year

8b. Other Rotation:  

9. Does your PE program meet the National Association of Sports, and Physical Education (NASPE) guidelines (Instruction periods totaling 150 minutes per week (elementary) and 225 minutes per week (middle and high school)?

Yes or No  

9b. If no, how long are the class periods? 

10. Indicate in each of the spaces provided the number of instructors presently teaching physical education in your school by certification.

a. Physical Education (K-8) 

b. Physical Education (9-12)

c. Health 

d. Other  

11. How has No Child Left Behind affected the physical Education program in your school (i.e., teachers, budget, class time, class size, scheduling)?

Name (Optional)

Thank you for your assistance and support!