Applicant Phone*Relationship to school*School District InformationSchool District*Full name of the school district your school is a part ofSchool District Website*The school district's website
School InformationSchool*School's full nameSchool Website*
Main Phone Number*Type of School*Elementary K-5Elementary K-3Elementary 4-6Junior / MiddleHigh SchoolK-6K-8K-12OtherSigned up with Active Schools?*Is your school signed up as an Active School? If not, please sign up at https://champion.activeschoolsus.org/signup.
To submit your application, please first signup with Active Schools as a school champion.
School InformationSchool Address*Please enter the shipping address for the school.
Address Line 2
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Student Enrollment*Total number of student's enrolled for current school year.# of boys enrolled*Number of students who are boys.# of girls enrolled*The number of students who are girls.% of Students on Free / Reduced Lunch*What percent of students at your school are on Free or Reduced Lunch?Please enter a number from 0 to 100.Principal Name*
Principal Phone NumberPrincipal Email*
Champion of AMPEDWho is the primary contact for AMPED, the AMPED Champion?
Champion's relationship to schoolWhat is the AMPED Champion's relationship to the school?Champion Phone*Champion Email*
Application QuestionsWhy should your school be awarded AMPED?*In 500 characters or less, please describe why your school should be awarded AMPED. Include how you will use this program, why you feel it is important for your school, and what impact you think it will make at your school.Commitment to Program*In 500 characters or less, please describe your school's philosophy around physical activity and what type of commitment your school has to implementing this type of programming. Include who is behind this program, what staff has offered to help and support this type of program, what type of funding does your school spend on physical activity.When will you start running AMPED?*Please provide a timeframe for when you will start AMPED at your school.What time of day will you run AMPED?*
Does your school currently have a running program?*
What running program do you currently have?*Does your school have a dedicated PE teacher?*
How much PE is offered?*How many days per week is PE offered (on average)?Have you received programming from KIDS in the GAME before?*
What programming have you received?Please tell us what you have received from us in the past.Year fundedWhat year did we provide your school funding?Please enter a number from 2011 to 2050.How did you hear about AMPED?*PHIT AmericaActive SchoolsShape AmericaSocial MediaAnother school / teacherPTO / PTA / Parent OrganizationStudentWeb searchOtherBuilding Your AMPED KitThese questions help us estimate the supplies you will need.How many days a week will you run AMPED?*
2 days a week (minimum required)
3 days a week
4 days a week
5 days a week
How many weeks a year will you run AMPED?*
All school year
Fall and Spring
Describe how many weeks AMPED will run.How many weeks will you run AMPED throughout the school year? Will all students have access to AMPED?*
Please explain who will have access to AMPED*How many kids will have access to AMPED? How are these kids selected?