EmailMe Form - CARDIAC Path Project

Date
MM / DD / YYYY
County *
School Name
Grade Level *
Pre-K
6
K
7
1
8
2
9
3
10
4
11
5
12
Age Range *
0-5
17-21
6-11
22-55
12-16
over 55
Number Impacted *
Did you distribute
Active Academics® *
Yes
No
Number of Schools that materials were distributed to: *
School Name where AA materials were distributed *
Please list the school name and number of cards (e.g. - School A - 20)
School Names where AA materials were distributed: *
Please list each school on a separate line and the number of cards. (e.g. - School A - 20)
Area of Focus *
School Related
Community Related
Both School & Community
Objectives *
Objective 1: Develop, organize, facilitate, or assist with a physical activity promotion program/event/initiative before, during, or after school
Objective 2: Provide educational materials on physical activity to teachers, students, parents, administrators, and/or community leaders
Objective 3: Participate in partnership meetings or on committees to facilitate physical activity in the school setting
Objective 4: Promote the WV PA Plan, and assist in providing information to the Plan website, and to the counties served (www.wvphysicalactivity.org)
Narrative: *
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Name *
First Last
Email *