Applications must be submitted on or before November 15, 2008.
Name: Title: Date:
School/Site Name:
School/Site Address:
School/Site Phone Number:
Number of children in grades K-5 served through physical education or physical activity programs:
Total number of hours per week currently dedicated to physical activity programming:
Number of hours per week that will be dedicated to Play On! Programming:
Required Administrative Approval – name(s), title(s), and contact information for the site administrator who has approved your participation in this research:

Name, position, and contact information for dedicated Elementary level PE or Recreation Professional that will serve as the PlayOn! Beta site leader. (responsible for implementing the program and providing feedback and data):

Contact information for the person responsible for playground purchasing decisions at your institution.
(regardless of whether you plan to purchase equipment as part of this project):

Specify the GameTime Play On! Activity Center that you are purchasing, or describe the playground you have currently. (we will be contacting you for photos in the case of existing equipment):
Describe why you want to participate in this research:

Include names of potential surrounding schools/school districts/community groups that could be invited to a Field Day training event should one be specified for your beta site:
Would you be interested in becoming a certified Play On! trainer? (No commitment required.):
Yes No
I have read and I understand the program, benefits, and requirements, and would like to apply.