PORTFOLIO CORE 6.1
80 Hour Physical Activity Requirement
Name: _________________ Grade: _______
Document participation in one or more physical activities that meet the moderate, vigorous, or
Tick (;) the type of evidence being used to satisfy this criterion:
Successfully complete Grade 11 Physical Education (attach a copy of your report card )
Successfully complete Grade 12 Physical Education (attach a copy of your report card )
80 hours of moderate to vigorous physical activity (hockey, chopping wood, snowboarding,
a Physical Activity Log and a “Declaration of Level and basketball, soccer…) (attach
Duration of Physical Activity”)
80 hours of adapted physical activity (If you are unable to meet regular moderate to vigorous
activity standards for health or physical reasons, attach a Physical Activity Log, a
physician’s note, and a “Declaration of Level of Duration of Physical Activity”.)
Discuss the reasons why or why not the physical activity you engaged in has had an affect upon your lifestyle choices (ie. changed eating habits, started doing physical activity above and beyond the cited sport, stopped smoking…).
Criteria #1 #2 #3 #4 #5 Total _____/5
Evaluator’s Signature:____________________ Date: ____________
DECLARATION OF LEVEL AND
This Declaration must be signed by a responsible adult who can attest to your participation in a physical activity. Such an official could be your sports coach, dance instructor, parent… ***** Separate declarations are required for each class of activity. For example, 40 hours of cross-country skiing and 40 hours of badminton would require two declarations.
Student ________________________________________________ [Please Print]
Witness Name ___________________________________________ [Please Print]
; Physical activity refers to any leisure or non-leisure body movement that expends energy. It
includes exercise, sports, dance, mobility training or physical therapy, extended brisk walking,
swimming or other body movements.
; Physical activity that counts as portfolio evidence must be either moderate or vigorous.
; Moderate physical activities increase the heart rate.
; Vigorous physical activities raise the heart rate and sustain the increase over time. Vigorous
activities are aerobic in nature, enhancing heart and lung health.
; The moderate or vigorous requirement is adaptable to meet student special needs (for adapted
To the best of my knowledge, the above student has completed
_______ hours of: moderate physical activities
vigorous physical activities
physical activities modified to meet the students special
needs (for adapted students only).
Provide a short description of all activities (ie. hockey, swimming, badminton, curling, soccer,
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Witness signature:______________________ Date: _______________
Physical Activity Log
Student Name: __________________
Date(s) Description of Physical Activity Hour(s)