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School Data Entry Form

This document is a BMI data entry form for collecting student information including name, SSN, guardian name, address, grade, date of birth, teacher and date of assessment. It includes fields to record height and weight measurements in pounds and inches, with instructions to re-measure if the first two height measurements differ by more than 1 inch. Reasons for being unable to assess measurements or collect student data are listed, including absence, disability, refusal, pregnancy, inability to get consistent height readings, exceeding scale limits or other reasons. The form also collects the school, district and county names.

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abhil
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119 views1 page

School Data Entry Form

This document is a BMI data entry form for collecting student information including name, SSN, guardian name, address, grade, date of birth, teacher and date of assessment. It includes fields to record height and weight measurements in pounds and inches, with instructions to re-measure if the first two height measurements differ by more than 1 inch. Reasons for being unable to assess measurements or collect student data are listed, including absence, disability, refusal, pregnancy, inability to get consistent height readings, exceeding scale limits or other reasons. The form also collects the school, district and county names.

Uploaded by

abhil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BMI DATA ENTRY FORM (School Year _____–_____)

Student Information
Student name: (FIRST Middle Initial LAST)
Student SSN:
Guardian name: (FIRST LAST)

Address: (Street, City, State, Zip)

Grade: (Pre-K, K, Student gender: (Male/Female)


02,04,06,08,10)
Date of birth: (MM/DD/YY) Teacher name:
Station # Assessment date: (MM/DD/YY)

Measurement Data
Note: Clearly indicate if you are using measurements other than pounds and inches
1st Height __ __ & ___ /8ths inches Weight __ __ __ . __ pounds
2nd Height __ __ & __ /8ths inches

If the difference between height measurements 1 and 2 is greater than 1 inch re-measure and
enter 3rd & 4th height
3rd Height __ __ & __ /8ths inches 4th Height __ __ & __ /8ths inches

Unable to Assess
Check a reason below if measurement or student data cannot be obtained

1. Absent 2. Physical disability 3. Student refused

4. Parent refused 5. No longer at this school 6. Student is pregnant

7. Could not get two height measurements within 1 inch

8. Other (insert comment)

9. Weight exceeded scale’s limit

School Information
SCHOOL NAME:
SCHOOL DISTRICT NAME:
COUNTY:

1401 West Capitol Avenue


Suite 300, Victory Building
Little Rock, Arkansas 72201
www.achi.net

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