Student Name__________________________ Semester: (circle)	1^st	2^nd
Grade ________	Room _________ Needs: Plaque or Medallion (Circle One)

General Requirements:
1. Student MUST have completed the season or activity and be in good standing to get credit.
2. Student MUST complete ALL items below, to be eligible for Block N.
3. 4^th grade needs 24 points total, 5^th & 6^th needs 26 points total.
Behavior: Any student who is suspended WILL NOT be eligible for Block N that semester.

MIND (Points required in this area)
Academic Area (MIND Section 1) | Points Poss. | Q1 | Q2 | Q3 | Q4
Principal’s Honor Roll(4.0 GPA) | 4 | | | |
Honor Roll (3.0 to 3.99 GPA) | 3 | | | |

Grade
 Improvement	
Met iReady
 Lesson Goals

1
	
2

Total section 1 points	S1: ________	S2:_______
MIND Section 2 | | 1^st Sem. | 2^nd Sem.
AR Award | 3 | |
GATE | 2 | |
Math Mastery | 2 | |
Computer Mastery | 2 | |
Essay Contest | 1 | |
Science Fair | 2 | |
History Day | 1 | |
Choir* | 1 | |
Orchestra* | 1 | |
Band* | 1 | |
Recorder Black Belt* | 1 | |
Drama | 2 | |
Mac N Kids | 1 | |
Spelling Bee | 1 | |
Oral Interp. | 2 | |
Art/Poster Contest | 1 | |
Perfect Attendance | 2 | |
TOTAL MIND | Sections 1 & 2 | |

*Students MUST PERFORM at winter and spring concerts for points.
*No behavior referrals in music classes to be eligible.

I have fulfilled all requirements for the Block N Award for the current semester. __________________________________
Student Signature	Date

Block N Application

BODY(Points are required in this area.)
Athletics | Points Poss. | 1^st Semester | 2^nd Semester
Football | 3 | |
Girls Volleyball | 3 | |
Cross Country | 3 | |
Basketball | 3 | |
Wrestling | 3 | |
Cheer | 3 | |
Baseball | 3 | |
Softball | 3 | |
Boys Volleyball | 3 | |
Track | 3 | |
PE* | 1 | |
Sports Manager | 2 | |
Intramurals | 1 | |
TOTAL BODY | | |
*1^st semester MUST pass mile time goal; 2^nd semester must pass ALL PE testing.

SPIRIT (Points are required in this area.)
Spirit Area | Points Poss. | 1^st Semester | 2^nd Semester
Ran for Student Council | 1 | |
Student Council (elected) | 3 | |
Classroom Representative | 1 | |
Peer Mediator | 2 | |
Photo Club | 2 | |
Library Helper | 1 | |
Cafeteria Worker | 1 | |
Campus Beautification | 1 | |
TOTAL SPIRIT | | |
*Outside Involvement Bonus | 1 | |

*1 bonus point may be added to the Spirit or Body section for outside involvement. Prior approval and additional form is required to receive point and MUST be attached.
Outside Involvement Form: Spirit or Body (circle one)

Mind:_____+ Body:____+ Spirit:____=_____ Total

Updated 8/16/2023

I have verified this student has earned the Block N Award for the current semester. __________________________________
Teacher Signature	Date