Classroom Hands-Up Travel Survey Fall 2011 for all Yukon elementary schools

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1. School Name

School Name   Christ the King Elementary École Émilie Tremblay Elijah Smith Elementary Golden Horn Elementary Grey Mountain Primary Hidden Valley Elementary Holy Family Elementary Jack Hulland Elementary Selkirk Elementary Takhini Elementary Whitehorse Elementary Chief Zzeh Gittlit

Ghùch Tlâ Community School Del Van Gorder Eliza Van Bibber J.V. Clark Johnson Elementary Kluane Lake Nelnah Bessie John School Robert Service Ross River St. Elias Community Tantalus Teslin

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2. Grade (check two grades if you have a split class)

Grade (check two grades if you have a split class)   Pre K K 1 2 3	4 5 6 7
Other (please specify)

3. Room / Class #

Room / Class #

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4. Total # of Students in Class

Total # of Students in Class

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5. Name of Teacher

Name of Teacher

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6. Enter month and date that survey took place

	Day	Month	Date
Start	MondayTuesdayWednesdayThursdayFriday Enter month and date that survey took place   Start   Day	SeptemberOctoberNovember Month	12345678910111213141516171819202122232425262728293031 Date
Finish	MondayTuesdayWednesdayThursdayFriday Finish   Day	SeptemberOctoberNovember Month	12345678910111213141516171819202122232425262728293031 Date

Other (please specify)