District, State and National Assessments - CALIFORNIA PHYSICAL FITNESS TEST FITNESSGRAM - lausd

 
District, State and National Assessments - CALIFORNIA PHYSICAL FITNESS TEST FITNESSGRAM - lausd
District, State and
    National Assessments

CALIFORNIA PHYSICAL FITNESS TEST
         FITNESSGRAM

 Spring 2018 Administration Instructions

LAUSD Testing Notebook Insert
   Los Angeles Unified School District
        Office of Data and Accountability
             Student Testing Branch
District, State and National Assessments - CALIFORNIA PHYSICAL FITNESS TEST FITNESSGRAM - lausd
This Page Intentionally Left Blank
FITNESSGRAM – SPRING 2018
                                                                                        Page 1

                  FITNESSGRAM Administration Instructions, Spring 2018
                                 Section Content

                                                                                     Page
Fact Sheet                                                                              2
Critical Dates                                                                          4

Administration Instructions
          Major Changes                                                                 5
          Important Reminders                                                           5
          Students to be Tested                                                         5
          Students Who May be Excluded                                                  5
          Tests to Administer                                                           6
          Materials Needed                                                              9
          Student Roster                                                                9
          Completing Pre-slugged Student Data Collection Forms                         10
          Completing Student Data Collection Forms Without Pre-slugged Information     11
          Makeup Testing                                                               12
          Completing the School Data Collection Form                                   12
          Returning Materials                                                          13
          Related Resources                                                            14
          Assistance                                                                   14

Attachments and Forms
         Returned Testing Materials Verification (Attachment A)                         15
         Certification of Proper Administration (Attachment B)                          16
         Back Saver Sit-and-Reach Box (Attachment C)                                    17
         Student Roster (Attachment D)                                                  18
         FITNESSGRAM Healthy Fitness Zones (Attachment E1 & E2)                      19-20
         School Data Collection Form (Attachment F)                                     21
         Student Data Collection Form (Attachment G)                                    22
         Request for Additional Testing Materials (Attachment H)                        23
         Testing Center Locations (Attachment I)                                        24
FITNESSGRAM – SPRING 2018
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                                              FACT SHEET

                                     California Physical Fitness Test
                                      FITNESSGRAM, Spring 2018

Students Tested

    State and District Requirement

    Grades 5, 7, and 9
       All students in grades 5, 7, and 9 are required to participate whether or not they are enrolled in
         a physical education class. NOTE: Only these state-mandated grades will be scored through
         the district’s Physical Fitness Test contractor.
       All students in grades 5, 7, and 9 who are on a block schedule, in alternate programs including
         continuation, independent study, CDS, and non-public schools are required to participate.
       All students must take physical education classes in high school for 2 years (freshman and
         sophomore). Freshman students in 2008 were the first class required to “pass”
         FITNESSGRAM in order to receive the exemption for physical education classes for 2 years
         (junior and senior). A “passing” score is defined as meeting the healthy fitness zone for 5 out
         of 6 components. Students who do not meet the healthy fitness zone in grade 9 or 10 will
         continue to take physical education classes until they “pass” the FITNESSGRAM or graduate.

    Grades 10, 11, and 12
       Schools are responsible for tracking and testing students in grades 10, 11, and 12 who have
         not met the healthy fitness zone in 5 out of 6 components of the FITNESSGRAM. Students
         only need to retake those components they did not pass in order to meet the healthy fitness
         zone in 5 out of 6 components of the FITNESSGRAM to qualify for the two-year physical
         education exemption. Questions on how to maintain records of student progress on the
         FITNESSGRAM, should be directed to Division of Instruction at (213) 241-6040.

Students Excluded from Testing

        There is no parent opt-out for this test.
        Students in grades 5, 7, and 9 who are physically unable to take the entire test battery must be
         given as much of the test as their condition permits.
        Students who are ill, injured, or enrolled for one-half or less of the work normally required for
         full-time students are eligible for a temporary exemption.
        A student may be eligible for a permanent exemption if they comply with one of the following:
         (i) is 16 or older and has been enrolled in the 10th grade one academic year or longer; (ii) is
         enrolled as a postgraduate student; or (iii) is enrolled in a juvenile home, ranch, camp or
         forestry camp.

Test Purpose

This information is used by federal, state, county and local agencies to assess the physical fitness of
California students.

Schools receive both school summary and individual student information. These data are used by
schools to determine the areas of concentration for physical education classes whose minutes of
FITNESSGRAM – SPRING 2018
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instruction are required by law. Schools must maintain Fitnessgram results in students’ cumulative
records.

Program Requirements and Test Description

The State Board of Education designated the FITNESSGRAM as the Physical Fitness Test (PFT) for
students in California public schools. The FITNESSGRAM is a comprehensive, health-related physical
fitness battery developed by the Cooper Institute. The primary goal of the FITNESSGRAM is to assist
students in establishing lifetime habits of regular physical activity.

In order to be eligible to graduate from high school, all students are required to take four years of
physical education, unless the District grants an exemption. Effective July 1, 2007, the two-year
exemption will be available to a student if the student “Passes” the PFT administered in grade 9 or 10. If
the student does not meet the Healthy Fitness Zone criteria, the student must continue to take physical
education classes and test in the areas of weakness. If the student passes the 5 of 6 events they would
then be exempt. “Passing” is currently identified as achieving the healthy fitness zone is 5 out of 6 of the
components of the FITNESSGRAM.

The FITNESSGRAM is composed of the following six fitness areas, with a number of test options
provided for most areas:

   Aerobic Capacity (select one)
    - PACER (Progressive Aerobic Cardiovascular Endurance Run)
    - One-Mile Run
    - Walk Test (only for ages 13 or older)

   Abdominal Strength and Endurance (required)
    - Curl-Up

   Upper Body Strength and Endurance (select one)
    - Push-Up
    - Modified Pull-Up
    - Flexed-Arm Hang

   Body Composition (required)
    - Body Mass Index

   Trunk Extensor Strength and Flexibility (required)
    - Trunk Lift

   Flexibility (select one test; both left and right sides must meet the criteria)
    - Back-Saver Sit and Reach
    - Shoulder Stretch
FITNESSGRAM – SPRING 2018
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                         LOS ANGELES UNIFIED SCHOOL DISTRICT
                              Office of Data and Accountability

                      FITNESSGRAM CRITICAL DATES – SPRING 2018

                                                         Delivery of Pre-ID   Scorables Due at
                      Test Dates         Create Pre-ID      To Schools         Testing Center
EL, Special Ed,
NPS                                      Dec 15, 2017    Jan 22-24, 2018
                  Feb 1 - Mar 20, 2018                                          Mar 21, 2018

MS, HS                                   Jan 18, 2018    Feb 12-14, 2018

          Make-up tests may be administered anytime during the scheduled testing period.
FITNESSGRAM – SPRING 2018
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                               ADMINISTRATION INSTRUCTIONS

Major Changes:        2017-18 Student Data Collection Forms will be Red in color.

Important             Schools will receive pre-slugged answer documents only for students in
Reminders:             grades 5, 7 and 9 after the testing window opens. Schools are not to wait for
                       the pre-slugged documents to start testing students.
                      The data collection process requires certificated staff to administer the PFT to
                       students and to record the results on the Student Data Collection Form.

2018 Training:     Fitnessgram Coordinators and teachers are required to participate in the 2018
                   Fitnessgram training in the Learning Zone. When returning materials to the
                   Testing Center, the Fitnessgram Coordinator will submit copies of the certificates
                   of completion from the Learning Zone.

Students to be     All students enrolled (including the physically handicapped) in grades 5, 7, and 9
Tested:            must be tested. This includes students in alternate programs including
                   continuation, independent study, CDS and non-public schools.
                   Students not enrolled in a physical education class during the testing window due
                   to a state-approved waiver for block scheduling, must still be tested. Schools on a
                   block schedule where students do not receive physical education for extended
                   periods of time (weeks or months), must ask the State Board of Education (SBE)
                   for a waiver or be in violation of Education Code (sections 51210 and 51222). A
                   copy of the Physical Education Block Schedule Waiver Criteria can be located on
                   the internet at http://www.cde.ca.gov/be/ms/po/policy99-03-June1999.asp.
                   Secondary schools are responsible for testing students in grades 10–12 who have
                   not “Passed” the FITNESSGRAM. Students only need to retake those
                   components they did not pass in order to meet the healthy fitness zone in 5 out of
                   6 components of the FITNESSGRAM to qualify for the two-year physical education
                   exemption. These schools are responsible for monitoring student progress and
                   maintaining student records. The Student Testing Branch will only collect and
                   report data for students in grades 5, 7 and 9.

Students Who       Students physically unable to take the various test components should be
May be Excluded:   administered as many parts of the tests as his or her condition will permit.
                   Nonetheless, the individual student’s welfare and safety are given first
                   consideration. A conference with the school nurse may be necessary.
                   The Individual Education Program (IEP) or Section 504 Plan team is responsible
                   for deciding how students with disabilities will participate in the PFT. See Matrix of
                   Variations, Accommodations and Modifications for Administration of the CAHSEE,
                   CELDT, and PFT at http://www.cde.ca.gov/ta/tg/ai/caasppmatrix2.asp.
                   Students who are ill, injured, or enrolled for one-half or less of the work normally
                   required for full-time students are eligible for a temporary exemption.
                   A student may be eligible for a permanent exemption if the student complies with
                   one of the following: (i) is 16 or older and has been enrolled in the 10th grade one
                   academic year or longer; (ii) is enrolled as a postgraduate student; or (iii) is
                   enrolled in a juvenile home, ranch, camp or forestry camp.
FITNESSGRAM – SPRING 2018
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Tests to      Schools are to administer the complete FITNESSGRAM test battery to measure
Administer:   student performance in each of the following six components of physical fitness
              identified in the FITNESSGRAM®/ACTIVITYGRAM® Test Administration Manual:
              aerobic capacity, body composition, abdominal strength, trunk strength, endurance
              and flexibility. The second, third, or fourth edition of the manual may be used.

              All tests must be administered by a District employee. Students may not
              administer the tests to each other.
              1. Body Composition (Required): Only BMI is used in LAUSD.
                 Body Mass Index (BMI): The body mass index provides an indication of the
                 appropriateness of a student’s weight (pounds) relative to height (feet and
                 inches.) Body mass index will be computer calculated from the height and
                 weight. Each student’s height and weight must be recorded on the answer
                 document. Do not use calipers or administer the skin fold test.
                 Test Administration Manual 2nd Edition, page 20.
                 Test Administration Manual 3rd and 4th Editions, page 38.
              2. Aerobic Capacity (Select one of the following three tests for each student.)
                 All three Aerobic Capacity test options are scored as estimates of VO2max. To
                 calculate VO2max for each student requires that height (feet and inches) and
                 weight (pounds) be collected for the One-Mile Run and the 20-meter Progres-
                 sive Aerobic Cardiovascular Endurance Run (PACER.) Weight (pounds) only is
                 required for the Walk Test. To ensure students can be properly scored and
                 reported for Aerobic Capacity, it is required that height (feet and inches) and
                 weight (pounds) be collected for every student tested for Aerobic Capacity.
                 One-Mile Run – the objective is to run a mile at the fastest pace possible. If a
                 student cannot run the total distance, walking is permitted. The one-mile run is
                 scored in minutes and seconds.
                 Test Administration Manual 2nd Edition, page 15.
                 Test Administration Manual 3rd and 4th Editions, pages 32-33.
                 PACER (Progressive Aerobic Cardiovascular Endurance Run) – the objective
                 is to run as long as possible back and forth across a 20-meter space at a
                 specified pace using the CD that will give a 5-second countdown and tell the
                 students when to start. In the PACER test, a lap is one 20-meter distance (from
                 one end to the other.) The recorded score is the total number of laps
                 completed by the student. A 15-meter test is described in some materials. If
                 the 15-meter test is used, the results must be converted to 20-meter scores.
                 The 15-meter PACER conversion table document can be viewed and
                 downloaded from the Human Kinetics FITNESSGRAM PACER Conversion
                 Web document at http://www.fitnessgram.net/pacer_conversion.pdf.
                 Test Administration Manual 2nd Edition, pages 11-12.
                 Test Administration Manual 3rd and 4th Editions, pages 28-32.

                 Walk Test – the objective is to walk one mile as quickly as possible while
                 maintaining a constant walking pace the entire distance. At the conclusion of
                 the one-mile walk, each student is given a time in minutes and seconds and
                 each student must take a 1-minute heart rate. The range of acceptable values
                 for the heart rate is between 30 and 250. The student’s body weight must also
FITNESSGRAM – SPRING 2018
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   be recorded. This test is ONLY for use with students thirteen years old or older.
   Test Administration Manual 2nd Edition, page 16.
   Test Administration Manual 3rd and 4th Editions, pages 33-34.

   NOTE: The maximum time allowed on the One-Mile Run is 13 minutes, or the
   minimum score allowed on the 20-meter PACER is 10 laps. Students with
   One-Mile Run times greater than 13 minutes or PACER scores of less than 10
   laps will be reported as Needs Improvement. The time of 59 minutes and 59
   seconds must only be used to indicate students who attempted the One-Mile
   Run or Walk Test but did not complete it. Students with 59 minutes and 59
   seconds will be reported as Needs Improvement.

3. Upper Body Strength and Endurance (Select one of the following 3 tests.)
   Push-Up – the objective is to complete as many push-ups as possible at a
   rhythmic pace. This test item is used for males and females. The student
   being tested bends the elbow to a 90º angle. Students are stopped when the
   second form correction is made. The score is the number of push-ups
   performed to a maximum of 75.
   Test Administration Manual 2nd Edition, page 25-26.
   Test Administration Manual 3rd and 4th Editions, pages 47-49.

   Modified Pull-Up – the objective is to complete as many modified pull-ups as
   possible. The student grasps the bar with an overhand grip (palms facing away
   from the body). Students begin the test in a “down” position with arms and legs
   straight. The student then pulls up until the chin is above the elastic band.
   Students are stopped when the second form correction is made. The score is
   the number of pull-ups performed to a maximum of 75.
   Test Administration Manual 2nd Edition, page 26-27.
   Test Administration Manual 3rd and 4th Editions, pages 49-50.
   Flexed Arm Hang – the objective of this test is to hang with the chin above the
   bar as long as possible. The student raises the body off the floor to a position
   where the chin is above the bar, elbows are flexed and the chest is close to the
   bar. Students are stopped when the chin drops below the bar or when the
   second form correction is made. The score is the number of seconds the
   student is able to maintain the correct hanging position to a maximum of 90.
   Test Administration Manual 2nd Edition, page 28
   Test Administration Manual 3rd and 4th Editions, pages 52-53
4. Abdominal Strength (Required)
   Curl-Up – the objective is to complete as many curl-ups as possible at a
   specified pace. A measuring strip is placed on the mat under the legs so that
   fingertips are just resting on the nearest edge of the measuring strip. Students
   are stopped after completing a maximum of 75 curl-ups or when the second
   form correction is made. The score is the number of curl-ups performed.
   Test Administration Manual 2nd Edition, page 21-23.
   Test Administration Manual 3rd and 4th Editions, pages 42-44.
FITNESSGRAM – SPRING 2018
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5. Flexibility (Select one test. Both left and right sides must be tested.)
   Back Saver Sit and Reach – the objective of this test is to be able to reach
   the specified distance on the right and left sides of the body. The distance
   required to achieve Healthy Fitness Zone is adjusted for age and gender. The
   score is the number of inches on each side to the nearest half-inch reached to
   a maximum score of 12 inches. Both left and right sides must be completed. If
   your sit-and-reach box is calibrated in centimeters, use Attachment B for
   modification instructions.
   Test Administration Manual 2nd Edition, page 29.
   Test Administration Manual 3rd and 4th Editions, pages 53-55.
   Shoulder Stretch – the objective is to be able to touch the fingertips together
   behind the back by reaching over the shoulder and under the elbow. If the
   student is able to touch the fingers of the left hand with the right hand over the
   shoulder, a “P” is recorded for the right side; if not, an “F” is recorded. If the
   student is able to touch the fingers of the right hand with the left hand over the
   shoulder, a “P” is recorded for the right side; if not, an “F” is recorded. Both
   sides must be scored.
   Test Administration Manual 2nd Edition, page 30.
   Test Administration Manual 3rd and 4th Editions, pages 55-56.
   NOTE: In the proper administration of the PACER, Curl-Up, Push-Up, and
   Modified Pull-Up, a student is allowed two form breaks with the first form break
   counting as a repetition or lap. A student who commits two form breaks
   immediately upon the start of the test is scored a one (1). A score of zero (0)
   is not allowed for any of these four tests. If the student does not participate,
   it should be left blank.

6. Trunk Extensor Strength and Flexibility (Required)
   Trunk Lift – the objective is to lift the upper body off the floor using the
   muscles of the back and hold the position to allow for the measurement. Do not
   encourage students to rise higher than 12 inches. The score is recorded to the
   nearest inch. Distances above 12 inches should be recorded as 12 inches. Do
   not place the ruler directly under the student’s chin.
   Test Administration Manual 2nd Edition, page 23-24.
   Test Administration Manual 3rd and 4th Editions, pages 45-47.

  Note: A score of “1” indicates the student committed two form breaks on the
  following tests:
          PACER, Curl-up, Push-up, and Modified Pull-up
  A score of “1” is the minimum score for these tests. A score of “0” cannot
  be documented on the above tests.

  Note: A score of “0” indicates the student attempted the test and scored a
  “0” on the following tests:
          Flexed Arm Hang, Trunk Lift, and Back Saver Sit and Reach
FITNESSGRAM – SPRING 2018
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Materials Needed:   Additional FITNESSGRAM materials can be ordered using the order form found on
                    Attachment H of these Administration Instructions.

                    1. FITNESSGRAM Forms
                        Physical Fitness Test Student Data Collection Form – All test results MUST
                          be recorded on these machine scorable forms.
                        Physical Fitness Test School Data Collection Form – Schools should
                          complete only one of these forms for their school.

                    2. FITNESSGRAM Materials
                       The following FITNESSGRAM materials from the kits previously sent to
                       schools are needed for the test administration:
                        The Prudential FITNESSGRAM Test Administration Manual (the 2nd, 3rd
                          and 4th editions are appropriate to use)
                        Curl-Up Measuring Strips

                       NOTE: The FITNESSGRAM Kits sent to schools in previous years
                       included the Test Administration Manuals, CDs, and Curl-Up Strips.
                       These materials were delivered with instructions to store safely for future
                       grade 5 teachers and grade 7 and 9 physical education teachers.

                    3. Materials provided by the school
                        Number 2 pencils (DO NOT USE INK OR MARKERS.)
                        Scale to measure height and weight

                    If the following FITNESSGRAM test options are selected, they will require
                    special equipment:

                            Sit-and-Reach Box (see Attachment C.)
                             Note: The Sit-and-Reach Box used before 1997 was calibrated in
                             centimeters. The FITNESSGRAM requires inches. To convert the old Sit-
                             and-Reach Box, glue an 18-inch ruler on top of the box matching the 23rd
                             centimeter with the 9th inch of the ruler.
                            Measured area for the PACER and PACER CD
                            Horizontal bars for Flexed-Arm Hang
                            Modified pull-up stand for Modified Pull-Ups
                           If a school does not have the facilities or equipment for these tests,
                           other FITNESSGRAM test options should be selected.

Student Roster:     A Student Roster of all students in grades 5, 7, and 9 is required to be turned in to
                    the Testing Center. This roster is available in MiSIS and includes spaces to write
                    test results. The column on the far right is to record the reason a student is missing
                    data. This roster also acts as a backup in the event answer documents are
                    destroyed, lost, or damaged. Schools may also use the generic PFT Class Roster
                    available on the Student Testing Branch website, on the Physical Fitness Test
                    (Fitnessgram) page. The Student Roster is available from the MiSIS Reports tab,
                    under the Testing section.

                    The data collected on these rosters must be transferred to the machine-scorable
FITNESSGRAM – SPRING 2018
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                    documents before the Testing Center turn-in. A copy of this roster must be kept at
                    the school until testing results are received.
                    For students who are unable to complete the FITNESSGRAM, indicate on the
                    roster the reason:
                            1. Absent on test day and all make up sessions
                            2. IEP/Special Needs
                            3. Medical Excuse
                    After testing, it will be the school coordinator’s responsibility to collect, pack, and
                    return the FITNESSGRAM scorable documents to the school’s Testing Center.
                    Schools are also required to submit a copy of the completed student roster
                    with their materials.

Completing          Schools will receive pre-slugged Student Data Collection Forms for all students
Pre-slugged         enrolled in grades 5, 7, and 9. The NSLP and Parent Education Level fields have
Student Data        been purposely left blank. There is no need to bubble these fields on the Pre-
Collection Forms:   slugged answer documents. The following sections must be entered and/or
                    bubbled on all pre-slugged forms:

                     NOTE: A blank indicates the test was not administered to the student.
                     Student records with blanks must include a valid reason on the Student
                     Roster.
                    1. Test Date
                       Schools must enter and bubble the Test Start Date only for students tested
                       during make-up sessions.
                    2. Box 1: Body Composition
                       Enter and bubble the height in feet and inches and the weight in pounds.
                    3. Box 2: Aerobic capacity (Select one test)
                       Enter and bubble the data for the test administered to the student (One-Mile
                       Run, PACER or Walk Test). Enter a 1-minute heart rate for Walk Test.
                    4. Box 3: Strength & Endurance (Select one test)
                       Enter and bubble the data for the test administered to the student (push-ups
                       (max=75), modified pull-ups (max=75) or flexed arm hang (max=90)).
                    5. Box 4: Flexibility (Select one test)
                       Enter and bubble the data for the test administered to the student (sit & reach –
                       maximum distance 12 inches, or shoulder stretch). Both right and left sides
                       must be tested.
                    6. Box 5: Abdominal Strength – Abdominal Curl-Ups
                       Enter and bubble the number of curl-ups performed. The maximum number of
                       curl-ups is 75.
                    7. Box 6: Trunk Strength – Trunk Lift
                       Enter and bubble the number of inches student lifted trunk from the ground.
                       The maximum distance from the ground is 12 inches.
FITNESSGRAM – SPRING 2018
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Completing         Students who do not have a pre-slugged Student Data Collection Form must have
Student Data       all the student demographic information fields gridded on a form. Use the Fitness
Collection Forms   Student Testing Information Report in MiSIS to obtain the required student
Without Pre-       demographic information. The Fitness Student Testing Information Report is
slugged            available from the MiSIS Reports tab, under the Testing section.
Information:
                    NOTE: A blank indicates the student was not administered the test.
                    Student records with blanks should include a valid reason on the Student
                    Roster.
                   1. School and Teacher/Period
                      Print the name of the school, teacher, and period if applicable.
                   2. Student’s Name
                      Print the last name, first name and middle initial in the name grid and darken
                      the corresponding bubble under each letter. For blank spaces, darken the
                      empty bubbles at the top of the grid.
                   3. Grade
                      Darken the student’s grade level.
                   4. Gender
                      Darken the appropriate bubble indicating “Male” or “Female.”
                   5. Birthdate
                      Print and bubble the month, day, and year.
                   6. Test Date
                      Schools must enter and bubble the Test Start Date only for students tested
                      during make-up sessions.
                   7. School Code
                      Enter and bubble the 7-digit County District School (CDS) code assigned to
                      your school by the California Department of Education (CDE)
                   8. Ethnicity
                      - Bubble “Yes” or “No” to indicate if the student is Hispanic or Latino.
                      - If “No” is marked for Hispanic or Latino, at least one ethnicity/race must be
                      bubbled.
                   9. Box 1: Body Composition
                      Enter and bubble the height in feet and inches and the weight in pounds.
                   10. Box 2: Aerobic capacity (Select one test)
                       Enter and bubble the data for the test administered to the student (One-Mile
                       Run, PACER or Walk Test). Enter a 1-minute heart rate for Walk Test.
                   11. Box 3: Strength & Endurance (Select one test)
                       Enter and bubble the data for the test administered to the student (push-ups
                       (max=75), modified pull-ups (max=75) or flexed arm hang (max=90)).
                   12. Box 4: Flexibility (Select one test)
                       Enter and bubble the data for the test administered to the student (sit & reach –
                       maximum distance 12 inches, or shoulder stretch). Both right and left sides
                       must be tested.
FITNESSGRAM – SPRING 2018
                                                                                      Page 12

                   13. Box 5: Abdominal Strength – Abdominal Curl-Ups
                       Enter and bubble the number of curl-ups performed. The maximum number of
                       curl-ups is 75.

                   14. Box 6: Trunk Strength – Trunk Lift
                       Enter and bubble the number of inches student lifted trunk from the ground.
                       The maximum distance from the ground is 12 inches.

                   15. Parent/Guardian Education Level
                       Bubble the education level of the most educated parent/guardian with whom
                       the student resides or “Declined to state or unknown.”

                   16. National School Lunch Program (NSLP)
                       Bubble “Yes” if student participates in the National School Lunch Program, free
                       or reduced-price lunch. Bubble “No” if student does not participate.

                   17. District ID
                       Print and bubble the student’s LAUSD District ID Number. This number
                       consists of the following:
                       - In columns 1-6, enter the birth date with leading zeros
                       - In column 7, enter the gender. Bubble 1 for male and 0 (zero) for female and
                         9 for X
                       - Columns 8-10 = District 3-digit serial number.

                   18. SSID Number
                       Enter the number from your MiSIS Fitness Student Testing Information Report.
                       Each student has been given an unique SSID number assigned by the CDE.

Makeup Testing:    Every effort should be made to provide makeup testing for students absent on the
                   days the tests are administered. Schools must enter the “TEST START DATE” on
                   the Student Data Collection Form if students are tested during a makeup session.

Completing the     Only one School Data Collection Form is required per school for the
School Data        FITNESSGRAM for grades 5, 7 and 9.
Collection Form:
                   The district name, school name, and county district school code will be pre-
                   slugged. Please verify that the pre-slugged information is correct. Schools using
                   a blank form must hand-bubble all the fields on the School Data Collection Form.

                      District Name
                       Complete and fill in the corresponding bubbles. For pre-slugged documents,
                       verify this information.

                      School Name
                       Complete and fill in the corresponding bubbles. For pre-slugged documents,
                       verify this information.
FITNESSGRAM – SPRING 2018
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                Test Date
                 - Print and bubble the date of the first day of testing for the students tested
                   during this administration. The date will be used for calculating the
                   results for all students except students with dates bubbled on the
                   Student Data Collection Forms.

                County-District-School Code
                 Enter and bubble the 14-digit County District School (CDS) code:
                 - In columns 1-2, enter the county code. The county code is 19.
                 - In columns 3-7, enter the district code. The district code is 64733.
                 - In columns 8-14, enter the school code. This is the seven-digit code
                   assigned to your school by the California Department of Education (CDE).

                Other Information
                 Leave Blank

                Charter School Code
                 Charter schools testing with the Los Angeles Unified School District must leave
                 the section blank.

                Number of Students Fully or Partially Tested at this School
                 Enter the number of students for all grades fully or partially tested at this
                 school and fill in the corresponding bubbles.

Returning    Return the following materials to the Testing Center:
Materials:    Attachment A – Returned Testing Materials Verification
              Attachment B – Certification of Proper Administration
              Student Roster of all students in grades 5, 7, and 9
              School Data Collection Form – One per school
              Student Data Collection Forms – Schools must submit a Student Data
                Collection Form for each student enrolled in grades 5, 7, and 9. If a student
                was not tested, the school must indicate on the Student Roster the reason why
                the student did not complete the test.

             Completed Student Data Collection Forms are to be stacked with all forms facing
             the same direction with a School Data Collection Form placed on top and wrapped
             with a paper band. Write the school name, location code, and grade(s) on the
             paper band.

             Span schools are to complete one School Data Collection Form for all grades
             tested at the school. Magnet schools and schools with Small Learning
             Communities may receive multiple School Data Collection Forms; however, only
             one School Data Collection Form should be turned in for the entire school unless
             the school has its own County-District-School (CDS) code.

             Testing materials must be returned to the school’s Testing Center by a school staff
             member. Do not send test materials by school mail to the Student Testing Branch
             or Testing Centers.
FITNESSGRAM – SPRING 2018
                                                                                 Page 14

Related          Questions regarding conditioning activities and test administration and for
Resources:        questions on how to maintain records of grade 10, 11 and 12 student progress
                  on the FITNESSGRAM are to be referred to the Division of Instruction at (213)
                  241-6040.
                 FITNESSGRAM manuals and materials should be retained at the school site
                  and used each year. The second, third and fourth editions of the
                  FITNESSGRAM manual may be used.

                 Free online training is available for test protocols at
                  http://www.fitnessgram.net/training. However, training is not designed to
                  comply with California Education Code Physical Fitness Testing or LAUSD
                  regulations.

                 Videos and training materials from the CDE PFT training sessions for PFT
                  coordinators are available on the CDE-sponsored PFT Training Web site at
                  http://www.pftdata.org/training.aspx.

Assistance:      Student Testing Branch (213) 241-4104.
FITNESSGRAM – SPRING 2018
                                                                                                     Page 15

                                                                                                     ATTACHMENT A

                            RETURNED TESTING MATERIALS VERIFICATION
                                   FITNESSGRAM, SPRING 2018

School:                                                                              19 - 64733 -
                                                             LD        Loc. Code                    CDS Code

Principal:
                               Name (type or print)                             Signature                         Date
FITNESSGRAM
Coordinator:
                               Name (type or print)                             Signature                         Date

                                                                                                               @lausd.net
                                 Contact Number                     Extension                   Email Address

 Complete two copies of this form and bring to the school’s Testing Center with the school’s testing materials.
 One copy is for the Testing Center and one copy will be stamped as your receipt.

Testing Center:        South            Central          Valley      West

Check that documents are packaged according to the Spring 2018                        TO BE             FOR OFFICE
Administration Instructions. Indicate number of documents and boxes being           COMPLETED            USE ONLY
delivered to testing center.                                                        BY SCHOOL
                                                                                                       Complete    Pending

Certification of Proper Administration (Attachment B)

Copy of Certificates of Completion – 2017-18 Fitnessgram Training

Student Roster

Copy of School Data Collection Form

Number of documents to be scored                                                                                  N/A

Number of envelopes and/or boxes of scorable documents                                                            N/A

FOR TESTING CENTER USE ONLY

No. of Envelopes Received: ___________
                                                      Received by:__________________           Date: ____________
No. of Cartons Received: _____________

Status:      School Needs to Return ____________           Incomplete ____________          Completed ____________
FITNESSGRAM – SPRING 2018
                                                                                                     Page 16

                                                                                                        ATTACHMENT B

                             CERTIFICATION OF PROPER ADMINISTRATION
                                     FITNESSGRAM, SPRING 2018

School:                                                                                        19 - 64733 -
                                                             LD         Location Code                    CDS Code

We certify that:

    1. The FITNESSGRAM was administered only to eligible students as defined in these Administration
       Instructions.

    2. All persons involved in the testing program and transcribers received training, which involved reviewing,
       planning and implementing the administration instructions; school schedules; administration procedures.

    3. All qualifying students were provided testing variations as needed.

    4. All students with IEPs and Section 504 Plans were provided the variations, accommodations, or
       modifications listed in their IEPs and Section 504 Plans. The appropriate documentation was recorded at
       the time of the test.

To the best of our knowledge there were no irregularities in the administration of the tests and the above
statements are accurate.

Principal:
                            Name (type or print)                                   Signature                        Date
FITNESSGRAM
Coordinator:
                              Name (type or print)                                 Signature                        Date

                               Contact Number                          Extension
FITNESSGRAM – SPRING 2018
                                                                                            Page 17

                                                                                           ATTACHMENT C

                                 BACK SAVER SIT-AND-REACH BOX
                                   FITNESSGRAM, SPRING 2018

A. Construction of a Back Saver Sit-and-Reach Box

   1. Using any study wood or comparable material (¾ inch plywood seems to work well) cut the
      following pieces:
              2 pieces – 12” X 12”
              2 pieces – 12” X 10 ½”
              1 piece – 12” X 22”
   2. Cut pieces 10” X 4” from each side of one end of the 12” X 22” piece to make the top of the box.
      (See diagram.) Beginning at the small end, make marks on the piece every inch up to 12 inches.
   3. Construct a box using nails or screws or wood glue from the remaining four pieces. Attach the top
      of the box. It is crucial that the 9 inch mark be exactly in line with the vertical plane against which
      the subject’s feet will be placed. The 0 inch is at end that will be nearest the subject.
   4. Cover the apparatus with polyurethane sealer or shellac.

B. Alternated Flexibility Testing Apparatus
   1. Find a sturdy cardboard box at least 12 inches tall. Turn the box so that the bottom is up. Tape a
       yardstick to the bottom. The yardstick must be placed so that the 9-inch mark is exactly in line
       with the vertical plane against which the subject’s feet will be placed and the 0-inch end is nearer
       the subject.
   2. Find a bench that is about 12 inches wide. Turn the bench on its side. Tape a yardstick to the
       bench so that the 9-inch mark is exactly in line with the vertical plane against which the subject’s
       feet will be placed and the 0-inch end is nearer the subject.

C. Modification
      To modify a sit and reach box that is calibrated in centimeters, glue an 18-inch ruler on top of the
      box matching the 23rd centimeter with the 9th inch of the ruler.
FITNESSGRAM – SPRING 2018
                                                                                                                                                                           Page 18

                                                                                                                                                                                 ATTACHMENT D
                                                                              STUDENT ROSTER
                                                                          FITNESSGRAM, SPRING 2018
 School:
                                                            Loc. Code            FITNESSGRAM Coordinator (type or print)                       Coordinator’s Signature                       Contact Number

                                                                                                                               Abdom./Trunk           Strength/                                     Reason
                                                                 Aerobic Capacity                     Body Composition                                                      Flexibility
                                                                                                                                  Streng.            Endurance                                    Student Not
TEST DATE:                                              One mile run          60 sec.                                                                 Push-ups           Sit & reach (inch)         Tested
                                                                                        PACER          Height       Weight   Curl-ups   Trunk Lift    Mod. pull-ups                                1. Absent
                                                        One mile walk*         heart                                                                                     Should. Stre. (P/F)
                                                                                                                                                     Flexed arm                                    2. IEP
              STUDENT NAME                   DOB       minutes      seconds    rate*    # of laps   feet   inches   pounds      #        inches      hang             right           left         3. Medical

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

      * 15 seconds heart rate is required for one mile walk test.
FITNESSGRAM – SPRING 2018
                  Page 19
          ATTACHMENT E1
FITNESSGRAM – SPRING 2018
                  Page 20
          ATTACHMENT E2
FITNESSGRAM – SPRING 2018
                                            Page 21
                                     ATTACHMENT F

SCHOOL DATA COLLECTION FORM
  FITNESSGRAM, SPRING 2018
FITNESSGRAM – SPRING 2018
                                             Page 22
                                     ATTACHMENT G

STUDENT DATA COLLECTION FORM
   FITNESSGRAM, SPRING 2018
FITNESSGRAM – SPRING 2018
                                                                                                          Page 23
                                                                                                   ATTACHMENT H

                               REQUEST FOR ADDITIONAL TESTING MATERIALS
                                       FITNESSGRAM, SPRING 2018

School:                                                                                                19 - 64733 -
                                                                      LD                Loc. Code               CDS Code

Principal:
                               Name (type or print)                                    Signature                           Date
FITNESSGRAM
Coordinator:
                                  Name (type or print)                                 Signature                           Date

                                   Contact Number                          Extension                             E-mail

Please indicate the number of additional materials required:

                                      FITNESSGRAM Materials                                         Quantity Needed

             Blank FITNESSGRAM Scannable Forms

             3.0 inch Curl-Up strips (for ages 5-9)

             4.5 inch Curl-Up strips (for ages 10-17+)

             PACER Lap Counter CD

   Please deliver to school

   Will pick up from Central Testing Center (2151 N. Soto Street, Los Angeles, CA 90032)

                                              FAX ORDER TO (213) 241-8461

FOR WAREHOUSE USE ONLY

Date filled:                                             Filled by:
FITNESSGRAM – SPRING 2018
                                                                                              Page 24
                                                                                       ATTACHMENT I

                                      TESTING CENTER LOCATIONS

Listed below are the Testing Center locations for delivery of testing materials. To find your school’s
assigned testing Center, refer to MEM-6901, Testing Center Assignments for 2017-18.

PLEASE NOTE: Testing Centers are not staffed year round, except for the Central Testing Center. All
materials must be turned in on the due date by 3:00 p.m. If the due date is missed, all testing materials must
be hand delivered Central Testing Center.

         LOCATION                                                        TELEPHONE AND
                                                                         FAX NUMBER

         CENTRAL TESTING CENTER                                          PHONE: (323) 224-2408
         2151 North Soto Street                                          FAX: (323) 224-3362
         Los Angeles, CA 90032                                           Open year round
         (Intersection of San Bernardino Fwy and Soto Street; north on
         Soto Street. Enter into Local District-East complex.)

         SOUTH TESTING CENTER                                            PHONE: (310) 366-7358
         Banneker Special Education Center                               FAX: (323) 224-3362
         14024 South San Pedro Street                                    Please call ahead, only open
         Los Angeles, CA 90061                                           on turn-in days.
         (Intersection Rosecrans and Main; east on Rosecrans ¼ mile to
         San Pedro St., left 1/10 mile.)

         VALLEY TESTING CENTER                                           PHONE: (818) 609-2591
         Mulholland Middle School                                        FAX: (323) 224-3362
         17120 Vanowen Street                                            Please call ahead, only open
         Lake Balboa, CA 91406                                           on turn-in days.
         Room 74-75
         (Intersection of Victory and Balboa, north on Balboa to
         Vanowen; Vanowen left one block)

         WEST TESTING CENTER                                             PHONE: (310) 836-1578
         Charnock Road Elementary School                                 FAX: (323) 224-3362
         11133 Charnock Road, Room 32                                    Please call ahead, only open
         Los Angeles, CA 90034                                           on turn-in days.
         (Intersection of Venice Blvd and Sepulveda Blvd; north on
         Sepulveda Blvd for ¼ mile)
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