AMPED

• Person filling out the grant

• Your Name*
  Name of the person completing the application
  First Last
• Your Phone Number*
• Your Work Email*
• Your Personal Email*
  Please provide a personal email in case your work email will not allow our emails through.
• Your role*
  Select your answerPrincipalPE TeacherChampion of bringing program to schoolOther

• School District Information

• School District*
  Full name of the school district your school is a part of
• School District Website*
  The school district's website

• School Information

• School*
  School's full name
• School Website*
• Main Phone Number*
• Type of School*
  Select your answerElementary K-5Elementary K-3Elementary 4-6Junior / MiddleHigh SchoolK-6K-8K-12Other
• Other Type of School*
  What grades do you serve?
• Old - Type of School
  • Elementary K-5
  • Elementary K-3
  • Elementary 4-6
  • Junior / Middle
  • High School
  • K-6
  • K-8
  • K-12
  • Other
• Signed 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.
  NoYes

• School Information

• School Address*
  Please enter the shipping address for the school.
  Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• 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?
• Principal Name*
  First Last
• Principal Phone Number*
• Principal Email*
• Champion of AMPED*
  Who is the person responsible for implementing AMPED at your school? We call this person the AMPED Champion.
  First Last
• Champion's relationship to school*
  What is the AMPED Champion's relationship to the school?
• Champion Phone*
• Champion Work Email*
• Champion Personal Email*
  In case our emails bounce due to district restrictions to work/school emails. Please provide a personal or secondary email so we can effectively communicate with you.

• Application Questions

• Why 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? (ie. Fall, Spring, next year)
• What time of day will you run AMPED?*
  Select all that apply
  • Select All
  • Before School
  • Recess
  • Lunch
  • After-school
  • During the day as breaks
• Does your school have a dedicated PE Teacher*
  Select your answerFull TimeHalf TimePart TimeNone
• How often per week are kids getting PE at your school?*
  How many days per week is each student getting PE (on average)?
• Are you currently holding a running program at your school?*
  Select your answerYesNo
• What are running program are you doing?*
• How did you hear about AMPED?*
  PHIT AmericaActive SchoolsShape AmericaSocial MediaAnother school / teacherStudentWeb searchPTOOther

• Building your AMPED Kit

• How many days a week will you run AMPED?*
  Select your answer2 days a week (minimum required)3 days a week4 days a week5 days a week
• How many weeks a year will you run AMPED?*
  Select your answerAll school yearSpring and FallFall onlySpring onlyOther
• Describe how many weeks AMPED will be run*
  How many weeks will you run AMPED throughout the school year? This helps us estimate the supplies you will need.
• Will All students have access to AMPED?*
  Please select answerYesNo
• Please explain who will have access to AMPED*
  How many kids will have access to AMPED? How are these kids selected?
• AMPED
  • True