Student Name:
SSID:
Physical Fitness Test (PFT)
Sample Student Data Collection Form
This form is for your convenience in collecting data for electronic submission.
Do not send this form to the state PFT contractor.
School Name:
STUDENT DEMOGRAPHICS
Grade Level:
○
Grade 5 ○ Grade 7 ○ Grade 9
Student Last Name:
Student First Name: Student Middle Initial:
PFT Test Date:
INDIVIDUAL STUDENT SCORES
Use the sections below to track student scores as well as test area participation.
Aerobic Capacity
Scores for One-Mile Run or One-Mile Walk should be recorded in minutes and seconds.
For example, eight minutes and fty-ve seconds should be recorded as 8:55. If the student begins
but cannot nish, ll in 59:59 for the time.
One-Mile Run or One-Mile Walk
Raw Score: Counted as participating?
○
Yes
○
No
Scores for Progressive Aerobic Cardiovascular Endurance Run (PACER) should be recorded
as the number completed.
PACER Test
Raw Score: Counted as participating?
○
Yes
○
No
Abdominal Strength
Scores for Curl-Up should be recorded as the number completed.
This score has a minimum of 1 and a maximum of 75.
Curl-Up
Raw Score: Counted as participating?
○
Yes
○
No
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