Section 1- School and District Information

After you have completed each page, save a copy for your records: Right-click, select Print, and then choose the pdf printer option.

School Health Data Report

Use this report to submit BMI or SBIRT data 

CSHS-funded schools will also use this report to submit end-of-year data 

(2022-2023 School Year)

General Guidelines

Submit only ONE report for the entire school district. (Do not submit a separate report for each school). This report should summarize the status of ALL the schools in the district. In most cases, this would include all schools in your Local Public School System and no others. Please add together numbers for all schools and enter only the district-wide totals. School Unions should preferably submit ONE report for all of the public schools included in the school union and affiliated regional school districts.

1. A. Name of person completing report:* 
    B. Position:*                                                 

2. Phone number:   
   Phone extension:

3. Email address:*   

5. Name of ______*

Submit one report per ______. 

6. If this report is for a school district but does not include data for all the schools in the district, please provide the name of the school or schools that are included in this report, followed by a list of the schools that are excluded from this report.
A. Included schools:
B. Excluded schools:

General Guidelines

Public school districts: Submit only ONE report for the entire school district. (Do not submit a separate report for each school). This report should summarize the status of ALL the schools in the district funded through the CSHS grant. In most cases, this would include all schools in your Local Public School System and no others. Please add together numbers for all schools where necessary (Section I, for example) and enter only the district-wide totals.  Grant recipients that include School Unions should preferably submit ONE report for all of the public schools covered by the grant.

Nonpublic schools: Submit one report for each nonpublic school.

All grant recipients:

1. Except where noted, please answer all questions with information that is current as of THE LAST DAY OF THE SCHOOL YEAR. Students who have transferred out of the district as of the last day of the school year should not be included in this report, even if they were included in monthly reports.
2. To ensure the accuracy and validity of your data, we strongly recommend that all school staff involved in the collection process maintain a program log for documenting information pertinent to this report.
3. The deadline for submitting completed Status Reports to MDPH is July 15, 2023.
4. For questions that pertain to descriptors or characteristics of:
   a) the students in your district or nonpublic school (number of students with asthma, for example) or
   b) the staff in your district or nonpublic school
   c) the features of your district or nonpublic school (number of schools with AEDs, for example),
   . . . answer questions with information that is current as of the last day of the school year. Those data should be a current snapshot of your district or nonpublic school, it is not cumulative (for example, do not count staff that worked for half the school year but are no longer working in your district or nonpublic school, and do not count students if they transferred out before the end of the school year).
5. For questions that ask for a tally of events (number of procedures, screenings, office visits, etc.), include only data for those students that were enrolled at the end of the school year (if the student transferred out of the district/school, do not include their data.) For these students, the count should be cumulative for the entire school year: count events from the first day of the school year to the last day of the school year. Do not include events that occurred during the summer break.

To save a copy for your records: print a pdf copy of each page of the report by right clicking and selecting "print".

To complete the rest of the report, click Submit.

To complete the rest of the report at another time: click Save and Return Later.