District, State and
National Assessments
CALIFORNIA PHYSICAL FITNESS TEST
FITNESSGRAM
Spring 2015 Administration Instructions
LAUSD Testing Notebook Insert
Los Angeles Unified School District
Office of Data and Accountability
Student Testing Branch
This Page Intentionally Left Blank
FITNESSGRAM Administration Instructions, Spring 2015
Section Content
FITNESSGRAM – SPRING 2015
Page 1
Fact Sheet
Critical Dates
Administration Instructions
Major Changes
Important Reminders
Students to be Tested
Students Who May be Excluded
Tests to Administer and Testing Schedules
Materials Needed
Student Roster
Completing Pre-coded Student Data Collection Forms
Completing Student Data Collection Forms Without Pre-coded Information
Makeup Testing
Completing the School Data Collection Form
Returning Materials
Related Resources
Assistance
Attachments and Forms
Returned Testing Materials Verification (Attachment A)
Certification of Proper Administration (Attachment B)
Back Saver Sit-and-Reach Box (Attachment C)
Roster of Students Tested (Attachment D)
FITNESSGRAM Healthy Fitness Zones (Attachment E1 & E2)
School Data Collection Form (Attachment F)
Student Data Collection Form (Attachment G)
Request for Additional Testing Materials (Attachment H)
Testing Center Locations (Attachment I)
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FITNESSGRAM – SPRING 2015
Page 2
FACT SHEET
California Physical Fitness Test
FITNESSGRAM, Spring 2015
Students Tested
State and District Requirement
Grades 5, 7, and 9
 All students in grades 5, 7, and 9 are required to participate whether or not they are enrolled in
a physical education class. NOTE: Only these state-mandated grades will be scored through
the district’s Physical Fitness Test contractor.
 All students in grades 5, 7, and 9 who are on a block schedule, in alternate programs including
continuation, independent study, CDS, and non-public schools are required to participate.
 All students must take physical education classes in high school for 2 years (freshman and
sophomore). Freshman students in 2008 were the first class required to “pass”
FITNESSGRAM in order to receive the exemption for physical education classes for 2 years
(junior and senior). A “passing” score is defined as meeting the healthy fitness zone for 5 out
of 6 components. Students who do not meet the healthy fitness zone in grade 9 or 10 will
continue to take physical education classes until they “pass” the FITNESSGRAM or graduate.
Grades 10, 11, and 12
 Schools are responsible for tracking and testing students in grades 10, 11, and 12 who have
not met the healthy fitness zone in 5 out of 6 components of the FITNESSGRAM. Students
only need to retake those components they did not pass in order to meet the healthy fitness
zone in 5 out of 6 components of the FITNESSGRAM to qualify for the two-year physical
education exemption. Questions on how to maintain records of student progress on the
FITNESSGRAM, should be directed to Chad Fenwick, Specialist, Instructional Support
Services at (213) 241-4556 or email [email protected].
Students Excluded from Testing
 There is no parent opt-out for this test.
 Students in grades 5, 7, and 9 who are physically unable to take the entire test battery must be
given as much of the test as their condition permits.
 Students who are ill, injured, or enrolled for one-half or less of the work normally required for
full-time students are eligible for a temporary exemption.
 A student may be eligible for a permanent exemption if they comply with one of the following:
(i) is 16 or older and has been enrolled in the 10th grade one academic year or longer; (ii) is
enrolled as a postgraduate student; or (iii) is enrolled in a juvenile home, ranch, camp or
forestry camp.
Test Purpose
These data are reported in the School Accountability Report Card (SARC). This information is used by
federal, state, county and local agencies to assess the physical fitness of California students.
Schools receive both school summary and individual student information. These data are used by
schools to determine the areas of concentration for physical education classes whose minutes of
FITNESSGRAM – SPRING 2015
Page 3
instruction are required by law. Parents are informed of the test results by mail. Schools must maintain
Fitnessgram results in students’ cumulative records.
Program Requirements and Test Description
The State Board of Education designated the FITNESSGRAM as the Physical Fitness Test (PFT) for
students in California public schools. The FITNESSGRAM is a comprehensive, health-related physical
fitness battery developed by the Cooper Institute. The primary goal of the FITNESSGRAM is to assist
students in establishing lifetime habits of regular physical activity.
In order to be eligible to graduate from high school, all students are required to take four years of
physical education, unless the District grants an exemption. Effective July 1, 2007, the two-year
exemption will be available to a student if the student “Passes” the PFT administered in grade 9 or 10. If
the student does not meet the Healthy Fitness Zone criteria, the student must continue to take physical
education classes and test in the areas of weakness. If the student passes the 5 of 6 events they would
then be exempt. “Passing” is currently identified as achieving the healthy fitness zone is 5 out of 6 of the
components of the FITNESSGRAM.
The FITNESSGRAM is composed of the following six fitness areas, with a number of test options
provided for most areas:

Aerobic Capacity (select one)
- PACER (Progressive Aerobic Cardiovascular Endurance Run)
- One-Mile Run
- Walk Test (only for ages 13 or older)

Abdominal Strength and Endurance (required)
- Curl-Up

Upper Body Strength and Endurance (select one)
- Push-Up
- Modified Pull-Up
- Flexed-Arm Hang

Body Composition (required)
- Body Mass Index

Trunk Extensor Strength and Flexibility (required)
- Trunk Lift

Flexibility (select one test; both left and right sides must meet the criteria)
- Back-Saver Sit and Reach
- Shoulder Stretch
FITNESSGRAM – SPRING 2014
Page 4
LOS ANGELES UNIFIED SCHOOL DISTRICT
Office of Data and Accountability
FITNESSGRAM CRITICAL DATES – SPRING 2015
Level / Track
Calendar
Single Track
Four Track



Test Dates
Date Pre-ID
Created
Delivery of Pre-ID
Materials to
Schools
Scorables Due at
Testing Center
(by 3 p.m.)
EL
February 2 - March 27
January 7
February 5 - 6
March 27
MS, HS
February 2 - March 27
January 27
February 25 - 26
March 27
Special Ed.
February 3 - April 10
January 8
February 5 - 6
April 14
Track A
February 13 - April 24
Track B
February 2 - March 22
Track C
February 2 – 12 &
March 27 - April 24
January 13
February 12 - 13
April 28
Track D
February 2 - April 10
Year-round and single track schools will receive one shipment for all test administrations. Schools with SIS will receive pre-coded
answer documents. Schools not on SIS will receive blank answer documents.
Make-up tests may be administered anytime during the scheduled testing period.
Early turn-ins will be accepted.
FITNESSGRAM – SPRING 2014
Page 5
ADMINISTRATION INSTRUCTIONS
Major Changes:

No major changes for the 2014-15 school year.
Important
Reminders:

Schools with MiSIS will receive pre-coded answer documents for students in
grades 5, 7 and 9 after the testing window opens. Schools are not to wait for
the pre-coded documents to start testing students.

Schools are responsible for testing students in grades 10, 11, and 12 who
have not met the criteria for the healthy fitness zone in 5 out of 6 components
of the FITNESSGRAM. Students only need to retake those components they
did not pass in order to meet the healthy fitness zone in 5 out of 6 components
of the FITNESSGRAM to qualify for the two-year physical education
exemption.
Students to be
Tested:
All students enrolled (including the physically handicapped) in grades 5, 7, and 9
must be tested. This includes students in alternate programs including
continuation, independent study, CDS and non-public schools.
Students not enrolled in a physical education class during the testing window
because of a state-approved waiver for block scheduling, must still be tested.
Schools on a block schedule where students do not receive physical education for
extended periods of time (weeks or months), must ask the State Board of
Education (SBE) for a waiver or be in violation of Education Code (sections 51210
and 51222). A copy of the Physical Education Block Schedule Waiver Criteria can
be located on the internet at http://www.cde.ca.gov/be/ms/po/policy99-03June1999.asp.
Secondary schools are responsible for testing students in grades 10, 11 and 12
who have not “Passed” the FITNESSGRAM. These schools are responsible for
monitoring student progress and maintaining student records. The Student
Testing Branch will only collect and report data for students in grades 5, 7 &
9.
Students Who
May be Excluded:
Students physically unable to take the various test components should be
administered as many parts of the tests as his or her condition will permit.
Nonetheless, the individual student’s welfare and safety are given first
consideration. A conference with the school nurse may be necessary.
The Individual Education Program (IEP) or Section 504 Plan team is responsible
for deciding how students with disabilities will participate in the PFT. See the
Matrix of Test Variations, Accommodations and Modifications for Administration of
California Statewide Assessments in Part 1 of the testing notebook.
All students must take physical education in high school for 2 years (freshman and
sophomore). Students who were freshman in 2008 were the first class required to
“pass” FITNESSGRAM in order to receive the exemption for physical education
classes for 2 years (junior and senior). A “Passing” score has been defined as
meeting the healthy fitness zone for 5 out of 6 components. Students who do not
meet the healthy fitness zone in 5 out of 6 components in grades 9 - 12 will
FITNESSGRAM – SPRING 2014
Page 6
continue to take physical education classes until they “Pass” or graduate.
Students who are either ill, injured, or enrolled for one-half or less of the work
normally required for full-time students are eligible for a temporary exemption.
A student may be eligible for a permanent exemption if the student complies with
one of the following: (i) is 16 or older and has been enrolled in the 10th grade one
academic year or longer; (ii) is enrolled as a postgraduate student; or (iii) is
enrolled in a juvenile home, ranch, camp or forestry camp.
Tests to
Administer and
Testing
Schedules:
Schools are to administer the complete FITNESSGRAM test battery to measure
student performance in each of the following six components of physical fitness
identified in the FITNESSGRAM®/ACTIVITYGRAM® Test Administration Manual:
aerobic capacity, body composition, abdominal strength, trunk strength, endurance
and flexibility. The second, third, or fourth edition of the manual may be used.
All tests must be administered by a school district employee. Students may
not administer the tests to each other.
1. Body Composition (Required): Only BMI is used in LAUSD.
Body Mass Index (BMI): The body mass index provides an indication of the
appropriateness of a student’s weight (pounds) relative to height (feet and
inches.) Body mass index will be computer calculated from the height and
weight. Each student’s height and weight must be recorded on the answer
document. Do not use calipers or administer the skin fold test.
Test Administration Manual 2nd Edition, page 20.
Test Administration Manual 3rd and 4th Editions, page 38.
2. Aerobic Capacity (Select one of the following three tests for each student.)
All three Aerobic Capacity test options are scored as estimates of VO2max. To
calculate VO2max for each student requires that height (feet and inches) and
weight (pounds) be collected for the One-Mile Run and the 20-meter PACER.
Weight (pounds) only is required for the Walk Test. To ensure that students
can be properly scored and reported for Aerobic Capacity, it is required that
height (feet and inches) and weight (pounds) be collected for every student
tested for Aerobic Capacity.
One-Mile Run – the objective is to run a mile at the fastest pace possible. If a
student cannot run the total distance, walking is permitted. The one-mile run is
scored in minutes and seconds.
Test Administration Manual 2nd Edition, page 15.
Test Administration Manual 3rd and 4th Editions, pages 32-33.
PACER (Progressive Aerobic Cardiovascular Endurance Run) – the objective
is to run as long as possible back and forth across a 20-meter space at a
specified pace using the audio-cassette that will give a 5-second countdown
and tell the students when to start. In the PACER test, a lap is one 20-meter
distance (from one end to the other.) The recorded score is the total number of
laps completed by the student. A 15-meter test is described in some materials.
If the 15-meter test is used, the results must be converted to 20-meter scores.
FITNESSGRAM – SPRING 2014
Page 7
The 15-meter PACER conversion table document can be viewed and
downloaded from the Human Kinetics FITNESSGRAM PACER Conversion
Web document at http://www.fitnessgram.net/pacer_conversion.pdf.
Test Administration Manual 2nd Edition, pages 11-12.
Test Administration Manual 3rd and 4th Editions, pages 28-32.
Walk Test – the objective is to walk one mile as quickly as possible while
maintaining a constant walking pace the entire distance. At the conclusion of
the one-mile walk, each student is given a time in minutes and seconds and
each student must take a 1-minute heart rate. The range of acceptable values
for the heart rate is between 30 and 250. The student’s body weight must also
be recorded. This test is ONLY for use with students thirteen years or older.
Test Administration Manual 2nd Edition, page 16.
Test Administration Manual 3rd and 4th Editions, pages 33-34.
NOTE: The maximum time allowed on the One-Mile Run is 13 minutes, or the
minimum score allowed on the 20-meter PACER is 10 laps. Students with
One-Mile Run times greater than 13 minutes or PACER scores of less than 10
laps will be reported as Needs Improvement. The time of 59 minutes and 59
seconds must only be used to indicate students who attempted the One-Mile
Run or Walk Test but did not complete it. Students with 59 minutes and 59
seconds will be reported as Needs Improvement.
3. Upper Body Strength and Endurance (Select one of the following 3 tests)
Push-Up – the objective is to complete as many push-ups as possible at a
rhythmic pace. This test item is used for males and females. The student
being tested bends the elbow to a 90º angle. Students are stopped when the
second form correction is made. The score is the number of push-ups
performed to a maximum of 75.
Test Administration Manual 2nd Edition, page 25-26.
Test Administration Manual 3rd and 4th Editions, pages 47-49.
Modified Pull-Up – the objective is to complete as many modified pull-ups as
possible. The student grasps the bar with an overhand grip (palms facing away
from the body). Students begin the test in a “down” position with arms and legs
straight. The student then pulls up until the chin is above the elastic band.
Students are stopped when the second form correction is made. The score is
the number of pull-ups performed to a maximum of 75.
Test Administration Manual 2nd Edition, page 26-27.
Test Administration Manual 3rd and 4th Editions, pages 49-50.
Flexed Arm Hang – the objective of this test is to hang with the chin above the
bar as long as possible. The student raises the body off the floor to a position
where the chin is above the bar, elbows are flexed and the chest is close to the
bar. Students are stopped when the chin drops below the bar or when the
second form correction is made. The score is the number of seconds the
student is able to maintain the correct hanging position to a maximum of 90.
Test Administration Manual 2nd Edition, page 28
Test Administration Manual 3rd and 4th Editions, pages 52-53
FITNESSGRAM – SPRING 2014
Page 8
4. Abdominal Strength (Required)
Curl-Up – the objective is to complete as many curl-ups as possible at a
specified pace. A measuring strip is placed on the mat under the legs so that
fingertips are just resting on the nearest edge of the measuring strip. Students
are stopped after completing a maximum of 75 curl-ups or when the second
form correction is made. The score is the number of curl-ups performed.
Test Administration Manual 2nd Edition, page 21-23.
Test Administration Manual 3rd and 4th Editions, pages 42-44.
5. Flexibility (Select one test. Both left and right sides must be tested.)
Back Saver Sit and Reach – the objective of this test is to be able to reach
the specified distance on the right and left sides of the body. The distance
required to achieve Healthy Fitness Zone is adjusted for age and gender. The
score is the number of inches on each side to the nearest half-inch reached to
a maximum score of 12 inches. Both left and right sides must be completed. If
your sit-and-reach box is calibrated in centimeters, use Attachment B for
modification instructions.
Test Administration Manual 2nd Edition, page 29.
Test Administration Manual 3rd and 4th Editions, pages 53-55.
Shoulder Stretch – the objective is to be able to touch the fingertips together
behind the back by reaching over the shoulder and under the elbow. If the
student is able to touch the fingers of the left hand with the right hand over the
shoulder, a “P” is recorded for the right side; if not, an “F” is recorded. If the
student is able to touch the fingers of the right hand with the left hand over the
shoulder, a “P” is recorded for the right side; if not, an “F” is recorded. Both
sides must be scored.
Test Administration Manual 2nd Edition, page 30.
Test Administration Manual 3rd and 4th Editions, pages 55-56.
NOTE: In the proper administration of the PACER, Curl-Up, Push-Up, and
Modified Pull-Up, a student is allowed two form breaks with the first form break
counting as a repetition or lap. A student who commits two form breaks
immediately upon the start of the test is scored a one (1). A score of zero (0)
is not allowed for any of these four tests. If the student does not participate,
it should be left blank.
6. Trunk Extensor Strength and Flexibility (Required.)
Trunk Lift – the objective is to lift the upper body off the floor using the
muscles of the back and hold the position to allow for the measurement. Do not
encourage students to raise higher than 12 inches. The score is recorded to
the nearest inch. Distances above 12 inches should be recorded as 12 inches.
Do not place ruler directly under the student’s chin.
Test Administration Manual 2nd Edition, page 23-24.
Test Administration Manual 3rd and 4th Editions, pages 45-47.
FITNESSGRAM – SPRING 2014
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Materials Needed:
Additional FITNESSGRAM materials can be ordered using Attachment I of these
Administration Instructions.
1. FITNESSGRAM Forms:
 Physical Fitness Test Student Data Collection Form – All test results
MUST be recorded on these machine scorable forms.
 Physical Fitness Test School Data Collection Form – Schools should
complete only one of these forms for their school.
2. FITNESSGRAM Materials
The following FITNESSGRAM materials from the kits previously sent to
schools are needed for the test administration:
 The Prudential FITNESSGRAM Test Administration Manual (The 2nd,
3rd and 4th editions are appropriate to use)
 Curl-Up Measuring Strips
NOTE: The FITNESSGRAM Kits sent to schools in previous years
included the Test Administration Manuals, cassettes, and curlup strips. These materials were delivered with instructions to
store safely for future grade 5 teachers and grade 7 and 9
physical education teachers.
3. Materials provided by the school
 Number 2 pencils (DO NOT USE INK OR MARKERS.)
 Scale to measure height and weight
If the following FITNESSGRAM test options are selected, they will require
special equipment:




Sit-and Reach Box (see Attachment C.)
Note: The Sit-and Reach Box used before 1997 was calibrated in
centimeters. The FITNESSGRAM requires inches. To convert the old Sitand Reach Box, glue an 18-inch ruler on top of the box matching the 23rd
centimeter with the 9th inch of the ruler.
Measured area for the PACER and PACER CD
Horizontal bars for Flexed-Arm Hang
Modified pull-up stand for Modified Pull-Ups
If a school does not have the facilities or equipment for these tests,
other FITNESSGRAM test options should be selected.
Student Roster:
A Student Roster of all students tested is required to be turned in to the Testing
Center. This roster with spaces to write test results is useful while on the field
collecting the results for students. It also serves as a backup in the event answer
documents are destroyed, lost, or damaged. This roster is currently not available in
MiSIS. In the meantime, schools may use the PFT Class Roster (Word version) to
print and hand fill students’ names. The document is available on the Student
Testing Branch website, on the Physical Fitness Test (Fitnessgram) page.
FITNESSGRAM – SPRING 2014
Page 10
The data collected on these rosters must be transferred to the machine-scorable
documents before the Testing Center turn-in. A copy of these rosters must be
kept at the school until testing results are received.
After testing, it will be the school coordinator’s responsibility to collect, pack, and
return the FITNESSGRAM scorable documents to the school’s Testing Center.
Schools are also required to submit a copy of the completed roster of all
students tested with their materials.
Completing
Pre-coded
Student Data
Collection Forms:
Schools with MiSIS will receive pre-coded Student Data Collection Forms for all
students enrolled in grades 5, 7, and 9. The following sections must be entered
and/or bubbled on all pre-coded forms:
NOTE: A score of 0 indicates the student attempted a test and scored a 0.
A blank indicates that the test was not administered to the student. Any
student records with blanks should include a valid reason. See 8 below.
1. Test Date
Schools must enter and bubble the first day of testing only for students tested
during make-up sessions.
2. Box 1: Body Composition
Enter and bubble the height in feet and inches and the weight in pounds.
3. Box 2: Aerobic capacity (Select one test)
Enter and bubble the data for the test administered to the student (One-Mile
Run, PACER or Walk Test). Enter a 1-minute heart rate for Walk Test.
4. Box 3: Strength & Endurance (Select one test)
Enter and bubble the data for the test administered to the student (push-ups
(max=75), modified pull-ups (max=75) or flexed arm hang (max=90)).
5. Box 4: Flexibility (Select one test)
Enter and bubble the data for the test administered to the student (sit & reach –
maximum distance 12 inches, or shoulder stretch). Both right and left sides
must be tested.
6. Box 5: Abdominal Strength – Abdominal Curl-Ups
Enter and bubble the number of curl-ups performed. The maximum number of
curl-ups is 75.
7. Box 6: Trunk Strength – Trunk Lift
Enter and bubble the number of inches student lifted trunk from the ground.
The maximum distance from the ground is 12 inches.
8. Reason for Student with Missing Data
The school must indicate why a student was not tested or has not completed
all six assessments:
- Absent on test day and all make up sessions
- IEP/Special Needs
FITNESSGRAM – SPRING 2014
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Completing
Student Data
Collection Forms
Without Precoded
Information:
Extraordinary circumstances (Needs Student Testing Branch approval)
Medical Excuse
Students who do not have a pre-coded answer document must have all the
student demographic information fields gridded on a blank answer document.
Schools may use the MiSIS CST Coding Roster to obtain the required student
demographic information. The CST Coding Roster is available from the MiSIS
Reports tab, under the Testing section.
NOTE: A score of 0 indicates the student attempted a test and scored a 0.
A blank indicates that the test was not administered to the student. Any
student records with blanks should include a valid reason. See 16 below.
1. School and Teacher/Period
Print the name of the school, teacher, and period if applicable.
2. Student’s Name
Print the last name, first name and middle initial in the name grid and darken
the corresponding bubble under each letter. For blank spaces, darken the
empty bubbles at the top of the grid.
3. Grade
Darken the student’s grade level.
4. Gender
Darken the appropriate bubble indicating “Male” or “Female.”
5. Birthdate
Print and bubble the month, day, and year.
6. Test Date
Schools must enter and bubble the first day of testing only for students tested
during make-up sessions.
7. School Code
Enter and bubble the 14 digit County District School (CDS) code:
- In columns 1-2, enter the county code. The county code is 19
- In columns 3-7, enter the district code. The district code is 64733
- In columns 8-14, enter the school code. This is the seven digit code
assigned to your school by the California Department of Education (CDE)
8. Ethnicity
- Bubble “Yes” or “No” to indicate if the student is Hispanic or Latino.
- If no is marked for Hispanic or Latino, at least one other ethnicity/race must
be bubbled.
9. Box 1: Body Composition
Enter and bubble the height in feet and inches and the weight in pounds.
10. Box 2: Aerobic capacity (Select one test)
Enter and bubble the data for the test administered to the student (One-Mile
FITNESSGRAM – SPRING 2014
Page 12
Run, PACER or Walk Test). Enter a 1-minute heart rate for Walk Test.
11. Box 3: Strength & Endurance (Select one test)
Enter and bubble the data for the test administered to the student (push-ups
(max=75), modified pull-ups (max=75) or flexed arm hang (max=90)).
12. Box 4: Flexibility (Select one test)
Enter and bubble the data for the test administered to the student (sit & reach –
maximum distance 12 inches, or shoulder stretch). Both right and left sides
must be tested.
13. Box 5: Abdominal Strength – Abdominal Curl-Ups
Enter and bubble the number of curl-ups performed. The maximum number of
curl-ups is 75.
14. Box 6: Trunk Strength – Trunk Lift
Enter and bubble the number of inches student lifted trunk from the ground.
The maximum distance from the ground is 12 inches.
9. Parent/Guardian Education Level
Bubble the education level of the most educated parent/guardian with whom
the student resides or “Declined to state or unknown.”
10. Reason for Student with Missing Data
The school must indicate why a student was not tested or has not completed
all six assessments:
- Absent on test day and all make up sessions
- IEP/Special Needs
- Extraordinary circumstances (Needs Student Testing Branch approval)
- Medical Excuse
11. National School Lunch Program (NSLP)
Bubble “Yes” if student participates in the National School Lunch Program, free
or reduced-price lunch. Bubble “No” if student does not participate.
12. District ID
Print and bubble the student’s LAUSD ID Number. This number consists of the
following:
- In columns 1-6, enter the birth date with leading zeros
- In column 7, enter the gender. Bubble 1 for male and 0 (zero) for female
- Columns 8-10 = District 3-digit serial number. Schools not on SIS leave
columns 8-10 blank.
13. SSID Number
Enter this number as it appears on your CST Coding Roster from MiSIS. Each
student has been given a SSID number assigned by the CDE.
Makeup Testing:
Every effort should be made to provide makeup testing for students absent on the
days the tests are administered. Schools must enter the “TEST DATE” on the
Student Data Collection Form if students are tested during a makeup session.
FITNESSGRAM – SPRING 2014
Page 13
Completing the
School Data
Collection Form:
Only one School Data Collection Form is required per administration of the
FITNESSGRAM for grades 5, 7 and 9.
 Single track schools with magnet programs must turn in only one School Data
Collection Form for the entire school.
 Year-round schools (with or without magnet programs) will complete a different
School Data Collection Form for each turn in.
 Span schools only complete one form for all grades tested at the school.
For Schools on MiSIS, the district name, school name, and county district school
code will be pre-coded. Please verify that the pre-coded information is correct.
Schools not on MiSIS must hand-bubble all the fields on the School Data
Collection Form.

District Name
Complete and fill in the corresponding bubbles. For pre-coded documents,
verify this information.

School Name
Complete and fill in the corresponding bubbles. For pre-coded documents,
verify this information.

-
Test Date
Print and bubble the date of the first day of testing for the students tested
during this administration. The date will be used for calculating the results
for all students except students with dates bubbled on the Student Data
Collection Forms.

County-District-School Code
Enter and bubble the 14 digit County District School (CDS) code:
- In columns 1-2, enter the county code. The county code is 19.
- In columns 3-7, enter the district code. The district code is 64733.
- In columns 8-14, enter the school code. This is the seven-digit code
assigned to your school by the California Department of Education (CDE).

Other Information
Leave Blank

Charter School Code
Charter schools testing with the Los Angeles Unified School District must leave
the section blank.

Number of Students Fully or Partially Tested at this School
Enter the number of students for all grades fully or partially tested at this
school and fill in the corresponding bubbles.
FITNESSGRAM – SPRING 2014
Page 14
Returning
Materials:
Return the following materials to the Testing Center:
 Attachment A – Returned Testing Materials Verification
 Attachment B – Certification of Proper Administration
 Student Roster of all students tested
 School Data Collection Form
 Student Data Collection Forms – Schools must submit a Student Data
Collection Form for each student enrolled in grades 5, 7, and 9. If a student
was not tested, the school must indicate on the form the reason why the
student did not test.
Completed answer sheets are to be stacked with all forms facing the same
direction with a School Data Collection Form placed on top and wrapped with a
paper band. Write the school name, location code, and grade on the paper band.
Span schools are to complete one form for all grades tested at the school. Magnet
schools and schools with Small Learning Communities may receive multiple
School Data Collection Forms; however, only one School Data Collection Form
should be turned in for the entire school unless the school has its own CountyDistrict-School (CDS) code. Year-round schools will complete a different School
Data Collection Form for each turn in.
Testing materials must be returned to the school’s Testing Center by a school staff
member. Do not send test materials by school mail to the Student Testing Branch
or Testing Centers.
Related
Resources:
Assistance:

Questions regarding conditioning activities and test administration and for
questions on how to maintain records of grade 10, 11 and 12 student progress
on the FITNESSGRAM are to be referred to Chad Fenwick at the Instructional
Support Services at (213) 241-4556 or email [email protected].

FITNESSGRAM manuals and materials should be retained at the school site
and used each year. The second, third and fourth editions of the
FITNESSGRAM manual may be used.

Free online training is available for test protocols at
http://www.fitnessgram.net/training. However, training is not designed to
comply with California Education Code Physical Fitness Testing or LAUSD
regulations.

Videos and training materials from the CDE PFT training sessions for PFT
coordinators are available on the CDE-sponsored PFT Training Web site at
http://www.pftdata.org/training.aspx.

Student Testing Branch (213) 241-4104.
FITNESSGRAM – SPRING 2014
Page 15
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FITNESSGRAM – SPRING 2014
Page 16
ATTACHMENT A
RETURNED TESTING MATERIALS VERIFICATION
FITNESSGRAM, SPRING 2015
19 - 64733 -
School:
ESC
Loc. Code
CDS Code
Principal:
Name (type or print)
Signature
Date
Name (type or print)
Signature
Date
FITNESSGRAM
Coordinator:
Contact Number
Extension
Complete two copies of this form and bring to the school’s Testing Center with the school’s testing materials.
One copy is for the Testing Center and one copy will be stamped as your receipt. Multi-track schools are to
submit separate forms for each turn in date.
Testing Center:
South
Check track(s) being submitted:
Central
Valley
Single Track
A
West
B
Check that documents are packaged according to the Spring 2015
Administration Instructions. Indicate number of documents and boxes being
delivered to testing center.
C
D
TO BE
COMPLETED
BY SCHOOL
Certification of Proper Administration (Attachment B)
Roster of Students Tested (Attach a copy of the roster to this sheet)
Copy of School Data Collection Form
Number of documents to be scored
Number of envelopes and/or boxes of scorable documents
FOR TESTING CENTER USE ONLY
No. of Envelopes Received: ___________
Received by:__________________
No. of Cartons Received: _____________
Date:
FOR TESTING
CENTER USE
ONLY
FITNESSGRAM – SPRING 2014
Page 17
ATTACHMENT B
CERTIFICATION OF PROPER ADMINISTRATION
FITNESSGRAM, SPRING 2015
19 - 64733 -
School:
ESC
Check track(s) being submitted:
Single Track
A
Location Code
B
C
CDS Code
D
We certify that:
1. The FITNESSGRAM was administered only to eligible students as defined in these Administration
Instructions.
2. All persons involved in the testing program and transcribers received training, which involved reviewing,
planning and implementing the administration instructions; school schedules; administration procedures
3. All qualifying students were provided testing variations as needed.
4. All students with IEPs and Section 504 Plans were provided the variations, accommodations, or
modifications listed in their IEPs and Section 504 Plans. The appropriate documentation was recorded at
the time of the test.
To the best of our knowledge there were no irregularities in the administration of the tests and the above
statements are accurate.
Principal:
Name (type or print)
Signature
Date
Signature
Date
FITNESSGRAM
Coordinator:
Name (type or print)
Contact Number
Extension
FITNESSGRAM – SPRING 2014
Page 18
ATTACHMENT C
BACK SAVER SIT-AND-REACH BOX
FITNESSGRAM, SPRING 2015
A. Construction of a Back Saver Sit-and-Reach Box
1. Using any study wood or comparable material (¾ inch plywood seems to work well) cut the
following pieces:
2 pieces – 12” X 12”
2 pieces – 12” X 10 ½”
1 piece – 12” X 22”
2. Cut pieces 10” X 4” from each side of one end of the 12” X 22” piece to make the top of the box.
(See diagram.) Beginning at the small end, make marks on the piece every inch up to 12 inches.
3. Construct a box using nails or screws or wood glue from the remaining four pieces. Attach the top
of the box. It is crucial that the 9 inch mark be exactly in line with the vertical plane against which
the subject’s feet will be placed. The 0 inch is at end that will be nearest the subject.
4. Cover the apparatus with polyurethane sealer or shellac.
B. Alternated Flexibility Testing Apparatus
1. Find a sturdy cardboard box at least 12 inches tall. Turn the box so that the bottom is up. Tape a
yardstick to the bottom. The yardstick must be placed so that the 9-inch mark is exactly in line
with the vertical plane against which the subject’s feet will be placed and the 0-inch end is nearer
the subject.
2. Find a bench that is about 12 inches wide. Turn the bench on its side. Tape a yardstick to the
bench so that the 9-inch mark is exactly in line with the vertical plane against which the subject’s
feet will be placed and the 0-inch end is nearer the subject.
C. Modification
To modify a sit and reach box that is calibrated in centimeters, glue an 18-inch ruler on top of the
box matching the 23rd centimeter with the 9th inch of the ruler.
FITNESSGRAM – SPRING 2015
Page 19
ATTACHMENT D
ROSTER OF STUDENTS TESTED
FITNESSGRAM, SPRING 2015
School:
Loc. Code
TEST DATE:
STUDENT NAME
DOB
Aerobic Capacity
One mile run
60 sec.
One mile walk*
heart
rate*
minutes
seconds
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
* 15 seconds heart rate is required for one mile walk test.
Coordinator’s Signature
FITNESSGRAM Coordinator (type or print)
Body Composition
PACER
# of laps
Height
feet
inches
Abdom./Trunk Streng.
Weight
Curl-ups
Trunk Lift
pounds
#
inches
Strength/Endurance
Push-ups
Mod. pull-ups
Flexed arm hang
Contact Number
Flexibility
Sit & reach (inch)
Should. Stre. (P/F)
right
left
FITNESSGRAM – SPRING 2014
Page 20
ATTACHMENT E1
FITNESSGRAM – SPRING 2015
Page 21
ATTACHMENT E2
FITNESSGRAM – SPRING 2015
Page 22
ATTACHMENT F
SCHOOL DATA COLLECTION FORM
FITNESSGRAM, SPRING 2015
FITNESSGRAM – SPRING 2015
Page 23
ATTACHMENT G
STUDENT DATA COLLECTION FORM
FITNESSGRAM, SPRING 2015
FITNESSGRAM – SPRING 2015
Page 24
ATTACHMENT H
REQUEST FOR ADDITIONAL TESTING MATERIALS
FITNESSGRAM, SPRING 2015
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School:
ESC
Loc. Code
CDS Code
Principal:
Name (type or print)
Signature
Date
Signature
Date
FITNESSGRAM
Coordinator:
Name (type or print)
Contact Number
Extension
E-mail
Please indicate the number of additional materials required:
FITNESSGRAM Materials
Quantity Needed
Blank FITNESSGRAM Scannable Forms
3.0 inch Curl-Up strips (for ages 5-9)
4.5 inch Curl-Up strips (for ages 10-17+)
PACER Lap Counter CD
Please deliver to school
Will pick up from Central Testing Center (2151 N. Soto Street, Los Angeles, CA 90032)
FAX ORDER TO (213) 241-8461
FOR WAREHOUSE USE ONLY
Date filled:
Filled by:
FITNESSGRAM – SPRING 2015
Page 25
ATTACHMENT I
TESTING CENTER LOCATIONS 2014-2015
Listed below are the testing center locations. Located on the Student Testing Branch’s webpage is the
Testing Center Assignments link, which lists each school’s assigned Testing Center
DISTRICTS/SPECIAL
EDUCATION
SCHOOLS
SOUTH
EAST
NORTH
WEST
LOCATION
TELEPHONE AND
FAX NUMBER
SOUTH TESTING CENTER-(NEW LOCATION)
14024 South San Pedro Street
Los Angeles, CA 90061
(Intersection Rosecrans and Main; east on
Rosecrans ¼ mile to San Pedro St., left 1/10 mile.)
PHONE:
(310) 366-7358
CENTRAL TESTING CENTER
2151 North Soto Street
Los Angeles, CA 90032
(Intersection of San Bernardino Fwy and Soto Street;
north on Soto Street. Enter into District 5 complex.)
PHONE:
(323) 224-2408
VALLEY TESTING CENTER
Mulholland Middle School
17120 Vanowen Street
Lake Balboa, CA 91406
Rooms 74-75
(Intersection of Victory and Balboa, north on Balboa
to Vanowen; Vanowen left one block.)
PHONE:
(818) 609-2591
WEST TESTING CENTER
Charnock Road Elementary School
11133 Charnock Road
Los Angeles, CA 90034
Room 32
(Intersection of Palms Blvd and Sepulveda, south on
Sepulveda one block; Charnock Road turn left)
PHONE:
(310) 836-1578
FAX:
(310) 366-6978
FAX:
(323) 224-3362
FAX:
(818) 609-2597
FAX:
(310) 836-1532