To be considered for the 2008-2009 school year, you must submit this application no later than July 1, 2009.

School Name:
Street Address:
City:
State:	Select State... ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING OTHER
Zip Code:
Phone:
Type of School: (check all that apply)	Elementary Middle Junior High Senior High Public School Private School Home School

Total Eligible Enrollment:
Enter the number of pupils ages 6 through 17 years old enrolled in the school on May 9, 2009 or the last official day of school (if earlier). This includes any 6-year-olds in kindergarten. Your school must have at least 50 students to be eligible to be an Active Lifestyle Model School.


Total Qualifying Students:
Enter the number of pupils who earned the Presidential Active Lifestyle Award at least twice during the 2008-2009 school year. This number must be at least 35% of total eligible enrollment for your school to qualify to be an Active Lifestyle Model School.


Upload
Upload your complete list of those who earned the Presidential Active Lifestyle Award (PALA) two or more times during the school year. Include each student's name, age, grade, gender and number of times s/he earned the Active Lifestyle Award. This file can either be an Excel (.xls) file, a Word Document (.doc) file, or a Text (.txt) file. Click the "Browse" button below and then choose the document from your computer to upload.



I certify that the information on this application is complete and accurate.

Phy. Ed. Teacher Name:
Principal Name: