PERSONAL FITNESS PLAN PE SCHEDULE PE NO.

NAME: _______________________________________ DATE: FROM __________ TO __________

FITNESS GOAL:
______________________________________________________________________________

Dietary Goal:
______________________________________________________________________________

Lifestyle Change:
(optional)_____________________________________________________________________

PHYSICAL FREQUENCY INTENSITY TYPE TIME Set

ACTIVITY
How often do I How hard do I What specific physical activity do I perform? How long do I perform How many times are
perform the physical perform the physical the physical activity? going to perform the
activity? activity? activity?
Warm up and
Stretching
(head to foot)

Workout proper

Workout proper

Workout proper

Workout proper

Workout proper

Cool down
(head to foot)
Remarks:

RUBRIC ON
Personal Fitness Plan (20 points)

20 points 15 points 10 points 5 points 0 points

Complete Insufficient Insufficient Insufficient None
information was information was information information was submission
provided (41 items) provided by the was provided provided by the
- Basic information student. Lacks 1 by the student. student. Lacks
(PE schedule, PE to 10 out of 41 Lacks 11 to 20 21 to 30 out of
number, Name, required out of 41 41 required
Date) information required information
- Fitness goal
information
- Dietary goal
- 7 Frequency
- 7 Intensity
- 7 Types of
activities
- 7 Time
- 7 Set

RUBRIC ON
PERSONAL GOAL ACHIEVEMENT
30 points

  Excellent Very Good Good Fair Poor  

  30 25 20 15 10 0
Level of Achieved Achieved Accomplished Maintained No set goals Non
Achievement beyond what what is below what is current participation
is expected expected expected fitness status