Active School Survey

First Name *	Last Name *


Email Address *

During School

Are healthy snacks available to students? *

Yes

No

Are nutritious and healthy choices offered in school vending machines? *

Yes

No

Are healthy eating reminders located throughout the school? *

Yes

No

Are students offered at least three activity breaks of 3- to 5-minutes in length throughout the school day (not including recess or lunchtime)? *

Yes

No

Are activity-promoting prompts and signs posted throughout the school? *

Yes

No

Curriculum

Does the PE program meet two or more days per week? *

Yes

No

Is a physical activity program offered to teachers and staff? *

Yes

No

Are students offered the opportunity to earn the President’s Challenge Active Lifestyle Award? *

Yes

No

Are Activity Contracts (similar to those in the President's Challenge Active Lifestyle Award) used to increase physical activity outside the school day? *

Yes

No

Does the school curriculum include a unit on healthy food choices? *

Yes

No

Recess/Lunch

Are students offered at least 15 minutes of recess daily? *

Yes

No

Are students offered 20 minutes or more of physical activity after lunchtime? *

Yes

No

Are healthy lunches (as certified by a school health agent) offered to students? *

Yes

No

For students who bring their lunches to school, are model lunch program recommendations available? *

Yes

No

After School

Is an after-school activity program available? *

yes

No

Are social support programs promoting physical activity available (such as "Walking Buddies" and small-group activity programs)? *

Yes

No

Are communications sent home to parents periodically to promote family activities? *

Yes

No

Does the school offer evening/weekend programs to encourage family activity and healthy eating? *

Yes

No

Is a newsletter sent home to parents encouraging healthy eating habits? *

Yes

No

Active and Healthy Schools Survey