Wellness and Physical Education Roger Rodriguez, Senior Coordinator, Health and Physical Education, Deadline: May 6, 2016 HB 5 Community and Student Engagement Campus Report Campus:_______________________ Principal: _______________________ Rev. 9/28/15Page 1 of 2 ACCEPTABLE: ALL compliance requirements completed Metric Campus Level IndicatorRequirement Date Completed C_W1ALL Student Teacher Ratio Physical Education classes have a 45 to 1 ratio of students to teacher. C_W2ALLMVPA The campus has Moderate to Vigorous Physical Activity (MVPA) level for 50% of the class period in a minimum of 3 observations (Various grade levels). C_W3ALLFitnessgram The campus conducts Fitnessgram Assessment for all non-exempt students in PE grades 3rd- 12 grade C-W4K-5 Program Implementation The campus implements and monitors the Administrative Procedure E-33 Recess Implementation such as, providing 15 consecutive minutes of recess and not withdrawing recess as a punishment. C_W4ALL Program Implementation The campus implements and monitors the Local Wellness Policy (FFA) such as: implementing the TEA/District approved Coordinated School Health Program (Bienestar, SPARK, Great Body Shop, etc.). C_W4ALL Program Implementation The campus has minutes weekly of structured Physical Education. RECOGNIZED: 3-5 completed Metric Campus Level IndicatorRequirement Date Completed RE_W1ALL Wellness Journals The campus implements and monitors student personal wellness journals and goals RE_W2ALLWellness Clubs The campus implements wellness clubs, such as student walking/running clubs, or PE3 clubs, parent wellness events RE_W3ALL Recess/ Intermurals The campus implements recess/intramurals during school hours. RE_W4ALLWellness FairThe campus holds a wellness/health fair for students and parents. RE_W5ALLCycling The campus holds a Bicycle Rodeo/Cycling Club/Field Day or participates in Siclovia. RE_W6ALL Community Wellness Activities The campus participates in Kid's Rock/Go Kids Challenge, San Antonio Sports Activities, First Tee Golf, Bowling Teams, Jump Rope for Heart, Hoops for Heart, Mayor's Student Ambassadors

Wellness and Physical Education Roger Rodriguez, Senior Coordinator, Health and Physical Education, Deadline: May 6, 2016 HB 5 Community and Student Engagement Campus Report Campus:_______________________ Principal: _______________________ Campus Self Rating - Please Circle one: Exemplary Recognized Acceptable Unacceptable Not Rated Campus Coordinator/Department Chair Signature_________________________________________________ Date ____________________ Principal Signature__________________________________________________________________________ Date ____________________ Rev. 9/28/15 Verified by: ___________________________________________ Title _________________________________ Date ___________________ Rating Verification – Final Campus Rating: Exemplary Recognized Acceptable Unacceptable Not Rated For District Department Use Only Page 2 of 2 EXEMPLARY: 3 or more completed Metric Campus Level IndicatorRequirement Date Completed RE_W1ALL Wellness Journals The campus monitors, and collaborates with classroom teachers about the student's personal wellness journal. RE_W2ALLZumba The campus holds, promotes, or participates in campus or District sponsored Zumba classes. RE_W3ALL Wellness Newsletter The campus publishes a wellness newsletter and recoginizes success stories which help improve wellness RE_W4ALLNutrition The campus holds nutrition classes/healthy cooking/recipes demonstrations for students and parents, gardens, etc. RE_W5ALL Community Wellness Activities The campus participates in local fitness activities such as the 4E Run (5k Walk/Run), Komen Race for the Cure, etc. RE_W6ALL Wellness Needs Analysis The campus completes the 'Let's Move Initiative' inventory or the School Health Index to help develop a Campus Wellness Plan RE_W7ALL Community Wellness Activities The campus provides opportunities for the community to participate in campus wellness activities. (CPR, Diabetes, Education, HIV/AIDS, etc. )

HB 5 Community and Student Engagement Campus Report Indicator: Wellness and Physical Education Campus: _________________ Principal: __________________ Campus Rating: __________________