• School Name:
  
• School Coordinator Name:
  
• Level achieving this year:
  Bronze Silver Gold

Bronze #1

• Attach Your Comprehensive Tobacco Policy:
  (MS Word, PDF or Text file)
• How many tobacco-free signs are posted at your School? 0 1 2 3 4 5 More than 5

Bronze #2

• List School Health Council members and their titles

  Title:	Name:
  Rows: |

• How many times did your School Health Council meet December - April?
• Attach minutes from one School Health Council meeting December - April
  (MS Word, PDF or Text file)

Bronze #3

• List Power-Up Committee members and grade level

  Type:	Name:	Grade:
  Committee Member Historian Mayor Publicity Officer Secretary
  Rows: |

• How many times did your Power-Up Committee meet December - April?
• Attach Power-Up Committee agreements with students' signatures: (MS Word, PDF or Text file)
• Attach minutes from one Power-Up Committee meeting December - April
  (MS Word, PDF or Text file)

Bronze #4

• What was the date of your Power-Up Kick off event?
  Month: JanFebMarAprMayJunJulAugSepOctNovDec Day: Year: 2007 2008 2009
• How did your Power-Up Committee create awareness of the Gold Medal Mile?
  
• How did your Power-Up Committee encourage student, faculty and staff participation?
  

Optional

• Tell us about other projects you completed that are associated with GMS Power-Up that you did not report on above
  
  Attach any pictures or related documents: