Speak Out for Healthy Kids

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INSTRUCTIONS
What is making your community unhealthy? What got low scores in your healthy
community investigation? Tell the leaders of your community or school how they can
solve the problem.

Fill out this form and KC Healthy Kids will send your ideas to your school and city leaders.

STUDENTS
If you want to share your work with your teacher, be sure to fill in your teacher's name, school name and school district on this page. If you are taking this for fun, you don't need to enter this information.

TEACHERS
If you would like to receive student answers complete the form found here: https://forms.gle/Mr4SS5bqrb3foY5Z8

Note for parents: KC Healthy Kids will not share names of students with city or school leaders. The names are only for your student's teacher using the Champions for Health lessons for credit.

Your First Name *

Your Last INITIAL ONLY (NO FULL LAST NAMES) *

Your City *

Your State *

Teacher's Name

School Name

School District

What is making your community unhealthy? There is a problem in my community. It is. . . *

I care about this problem because . . . *

As a city or school leader you can fix the problem by . . . *

This will help people in my community be healthy because . . . *

Which leaders would you like to send your answers to? *

Mayor and City Council

School Board and Superintendent

Both

Submit

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