Illinois Association for Health, Physical Education, Recreation & Dance
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Blue Ribbon Physical Education Application

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School Information (Step 1 of 5)

Application #
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School
District
Address
City
State
Zip
School Phone
School Fax
Principal Name
Superintendent Name
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Contact Information (Step 2 of 5)

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Contact Person
Home Phone
Address
City
State
Zip
Email
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Application Details (Step 3 of 5)

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Select a grade
Building Enrollment
% of Enrolled Students in P.E
If enrollment % less than 100, explain:
Enrollment Year
Average P.E. class size
% of classes that are Co-Educational
If class % less than 100, explain
Days per Week students have P.E. class
If days per week less than 5, explain
Minutes per day
% of full time certified P.E. teachers
School has one or more P.E. waivers?
Additional Notes

Teacher Roster (Step 4 of 5)

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Salutation
Name
Highest Degree
Certificate Type
Years at Present School
District
Total Years Teaching
IAHPERD Member?
 
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Submit (Step 5 of 5)

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