----------------------- ----- ----- -------------- -------------- ------------- ------------ ------------------------- ------------- -----------------------------
  **General Information**                                                                                                              

  **School Name**                                                                 **County**                                           

  **No. of                                           **No. of                     **No. of                                             
  Faculty/Staff**                                    Classrooms**                 Students**                                           

  **Primary Point of                                                **Secondary                                                        
  Contact**                                                         Point of                                                           
                                                                    Contact**                                                          

  **Name**                                                          **Name**                                                           

  **Title**                                                         **Title**                                                          

  **Mailing Address**                                               **Mailing                                                          
                                                                    Address**                                                          

  **City**                                                          **City**                                                           

  **State, ZIP**                                                    **State,                                                           
                                                                    ZIP**                                                              

  **Phone**                                                         **Phone**                                                          

  **e-mail**                                                        **e-mail**                                                         

  **Recognition                                                                                                                        
  Guidelines**                                                                                                                         

  **Guideline 1: All                  **- NWR                                                                            **Completed   
  Hazards NOAA Weather                located near                                                                       Yes:  No:    
  Radio (NWR) and                     the school's                                                                       **           
  Checklist**                         front office                                                                                     
                                      or                                                                                               
                                      supervisor's                                                                                     
                                      desk. Specific                                                                                   
                                      Area Message                                                                                     
                                      Encoder (SAME)                                                                                   
                                      NWR is highly                                                                                    
                                      recommended.                                                                                     
                                      Maintain                                                                                         
                                      weekly                                                                                           
                                      checklist to                                                                                     
                                      make sure the                                                                                    
                                      radio has been                                                                                   
                                      operating                                                                                        
                                      properly.**                                                                                      

  **[Verification Team                                                                                                                 
  General                                                                                                                              
  Notes:]{.underline}**                                                                                                                

                                                                                                                                       

                                                                                                                                       

                                                                                               **[Date:]{.underline}**                 **[Initials:]{.underline}**
  ----------------------- ----- ----- -------------- -------------- ------------- ------------ ------------------------- ------------- -----------------------------

  -------------------------- ------------------------------- ------------------------- ------------- -----------------------------
  **Guideline 2: Backup      **- Establish a backup method                             **Completed   
  Weather Information**      to receive weather information                            Yes:  No:    
                             (TV, EAS Radio Station,                                   **           
                             Internet, etc.) at the front                                            
                             office or supervisor's desk.**                                          

  **[Please                                                                                          
  Describe:]{.underline}**                                                                           

                                                                                                     

  **[Verification Team                                                                               
  General                                                                                            
  Notes:]{.underline}**                                                                              

                                                                                                     

                                                                                                     

                                                             **[Date:]{.underline}**                 **[Initials:]{.underline}**

  *Note: Please do not write                                                                         
  in shaded areas.*                                                                                  
  -------------------------- ------------------------------- ------------------------- ------------- -----------------------------

  ----------------------- ------------------------------- ------------------------- ------------- -----------------------------
  **Guideline 3: Tornado  **- Identify all potential                                **Completed   
  Shelter Areas**         tornado shelter areas on the                              Yes:  No:    
                          school grounds.**                                         **           

  **Please email a basic                                                                          
  floor-plan highlighting                                                                         
  tornado shelter areas                                                                           
  to this application                                                                             
  form to:                                                                                        
  Mark.Bacon@noaa.gov**                                                                           

  **[Verification Team                                                                            
  General                                                                                         
  Notes:]{.underline}**                                                                           

                                                                                                  

                                                                                                  

                                                          **[Date:]{.underline}**                 **[Initials:]{.underline}**
  ----------------------- ------------------------------- ------------------------- ------------- -----------------------------

  ------------------------------ -------------- ---------------------- --------- ------------------------- ------------- -----------------------------
  **Guideline 4: Annual Tornado  **- The school                                                            **Completed   
  Drills**                       is required to                                                            Yes:  No:    
                                 hold a tornado                                                            **           
                                 drill at least                                                                          
                                 twice per year                                                                          
                                 (recommended                                                                            
                                 early in the                                                                            
                                 school year                                                                             
                                 and prior to                                                                            
                                 the start of                                                                            
                                 severe weather                                                                          
                                 season in                                                                               
                                 March).**                                                                               

  **[Dates tornado drills                       **Drill 1:**           **Drill                                           
  completed                                                            2:**                                              
  (dd/mm/yyyy):]{.underline}**                                                                                           

  **[Verification Team General                                                                                           
  Notes:]{.underline}**                                                                                                  

                                                                                                                         

                                                                                                                         

                                                                                 **[Date:]{.underline}**                 **[Initials:]{.underline}**
  ------------------------------ -------------- ---------------------- --------- ------------------------- ------------- -----------------------------

  ----------------------- -- ---------------- ----------- ---- --------------- ------------------------- ---- ------------- -----------------------------
  **Guideline 5: Skywarn     **- Spotter                                                                      **Completed   
  Spotter Training**         training is                                                                      Yes:  No:    
                             required for a                                                                   **           
                             minimum of 10                                                                                  
                             teachers/staff                                                                                 
                             including the                                                                                  
                             Physical                                                                                       
                             Education                                                                                      
                             teacher(s) and                                                                                 
                             Principal and/or                                                                               
                             Vice                                                                                           
                             Principal.**                                                                                   

  **Date completed                            **Number         **Presenter's                                                
  (dd/mm/yyyy)**                              trained**        name**                                                       

  **[Verification Team                                                                                                      
  General                                                                                                                   
  Notes:]{.underline}**                                                                                                     

                                                                                                                            

                                                                                                                            

                                                                               **[Date:]{.underline}**                      **[Initials:]{.underline}**
  ----------------------- -- ---------------- ----------- ---- --------------- ------------------------- ---- ------------- -----------------------------

+-------------------+-------------------------------+----+---+---------+
| **Guideline 6:    | **- The HWO (required to be   |    | * |         |
| Hazardous Weather | posted) and Hazards Map need  |    | * |         |
| Outlook (HWO) and | to be reviewed at least twice |    | C |         |
| Hazard Display    | a day by a member of the      |    | o |         |
| Map**             | front office or supervisor.   |    | m |         |
|                   | (Recommended prior to the     |    | p |         |
|                   | start of school and around    |    | l |         |
|                   | noon.)**                      |    | e |         |
|                   |                               |    | t |         |
|                   |                               |    | e |         |
|                   |                               |    | d |         |
|                   |                               |    | Y |         |
|                   |                               |    | e |         |
|                   |                               |    | s |         |
|                   |                               |    | : |         |
|                   |                               |    |  |         |
|                   |                               |    | N |         |
|                   |                               |    | o |         |
|                   |                               |    | : |         |
|                   |                               |    |  |         |
|                   |                               |    | * |         |
|                   |                               |    | * |         |
+-------------------+-------------------------------+----+---+---------+
| **How is the HWO  |                               |    |   |         |
| accessed?**       |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
| **Where is the    |                               |    |   |         |
| HWO posted?**     |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
| **[Verification   |                               |    |   |         |
| Team General      |                               |    |   |         |
| Note              |                               |    |   |         |
| s:]{.underline}** |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
|                   |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
|                   |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
| **Hazardous       |                               | *  |   | **[Ini  |
| Weather Outlook   |                               | *[ |   | tials:] |
| (HWO) -**         |                               | Da |   | {.under |
| [**http://www     |                               | te |   | line}** |
| .weather.gov/ilm/ |                               | :] |   |         |
| products/hwo.shtm |                               | {. |   |         |
| l**](http://www.w |                               | un |   |         |
| eather.gov/ilm/pr |                               | de |   |         |
| oducts/hwo.shtml) |                               | rl |   |         |
|                   |                               | in |   |         |
| **Hazards Map -   |                               | e} |   |         |
| <http://www.w     |                               | ** |   |         |
| eather.gov/ilm>** |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+
| *Note: Please do  |                               |    |   |         |
| not write in      |                               |    |   |         |
| shaded areas.*    |                               |    |   |         |
+-------------------+-------------------------------+----+---+---------+

+-------------------+---------------+--------------+----+---+---------+
| **Guideline 7:    | **- Each      |              |    | * |         |
| Severe Weather    | school must   |              |    | * |         |
| Emergency Plan    | dev           |              |    | C |         |
| (SWEP)**          | elop/maintain |              |    | o |         |
|                   | a SWEP or     |              |    | m |         |
|                   | incorporate   |              |    | p |         |
|                   | weather       |              |    | l |         |
|                   | hazards into  |              |    | e |         |
|                   | their overall |              |    | t |         |
|                   | Emergency     |              |    | e |         |
|                   | Action Plan.  |              |    | d |         |
|                   | The SWEP or   |              |    | Y |         |
|                   | related       |              |    | e |         |
|                   | portion of    |              |    | s |         |
|                   | the Emergency |              |    | : |         |
|                   | Action Plan   |              |    |  |         |
|                   | must be       |              |    | N |         |
|                   | reviewed by   |              |    | o |         |
|                   | all staff at  |              |    | : |         |
|                   | least once a  |              |    |  |         |
|                   | year.**       |              |    | * |         |
|                   |               |              |    | * |         |
+-------------------+---------------+--------------+----+---+---------+
| **Date plan       |               | **Month all  |    |   |         |
| completed         |               | staff        |    |   |         |
| (dd/mm/yyyy)**    |               | reviewed     |    |   |         |
|                   |               | (mm/yyyy)**  |    |   |         |
+-------------------+---------------+--------------+----+---+---------+
| **Please indicate |               |              |    |   |         |
| if the Severe     |               |              |    |   |         |
| Weather Emergency |               |              |    |   |         |
| Plan has been     |               |              |    |   |         |
| developed as a    |               |              |    |   |         |
| stand-alone or    |               |              |    |   |         |
| directly          |               |              |    |   |         |
| incorporated into |               |              |    |   |         |
| other operational |               |              |    |   |         |
| manuals.**        |               |              |    |   |         |
|                   |               |              |    |   |         |
| **Developed as a  |               |              |    |   |         |
| stand-alone plan: |               |              |    |   |         |
|  Incorporated    |               |              |    |   |         |
| into Emergency    |               |              |    |   |         |
| Action Plan: **  |               |              |    |   |         |
+-------------------+---------------+--------------+----+---+---------+
| **[Verification   |               |              |    |   |         |
| Team General      |               |              |    |   |         |
| Note              |               |              |    |   |         |
| s:]{.underline}** |               |              |    |   |         |
+-------------------+---------------+--------------+----+---+---------+
|                   |               |              |    |   |         |
+-------------------+---------------+--------------+----+---+---------+
|                   |               |              |    |   |         |
+-------------------+---------------+--------------+----+---+---------+
|                   |               |              | *  |   | **[Ini  |
|                   |               |              | *[ |   | tials:] |
|                   |               |              | Da |   | {.under |
|                   |               |              | te |   | line}** |
|                   |               |              | :] |   |         |
|                   |               |              | {. |   |         |
|                   |               |              | un |   |         |
|                   |               |              | de |   |         |
|                   |               |              | rl |   |         |
|                   |               |              | in |   |         |
|                   |               |              | e} |   |         |
|                   |               |              | ** |   |         |
+-------------------+---------------+--------------+----+---+---------+

  ----------------------- ------------------------------- ------------------------- ------------- -----------------------------
  **Guideline 8:          **- Annual review of the                                  **Completed   
  Lightning Safety**      *Coaches & Sports Officials                               Yes:  No:    
                          Guide to Lightning Safety* by                             **           
                          all of the coaches and/or P.E.                                          
                          teachers at the school**                                                

  **[Verification Team                                                                            
  General                                                                                         
  Notes:]{.underline}**                                                                           

                                                                                                  

                                                                                                  

                                                          **[Date:]{.underline}**                 **[Initials:]{.underline}**
  ----------------------- ------------------------------- ------------------------- ------------- -----------------------------

  --------------------------------------- -------------------------------
  **Signature of Applying Official**      

  **[Application Submitted by: (print     
  name):]{.underline}**                   

  **[School:]{.underline}**               **[Title:]{.underline}**

  **[Signature:]{.underline}**            **[Date:]{.underline}**

  **[NWS Personnel Receiving Application  
  (print name):]{.underline}**            

  **[Date Received:]{.underline}**        

  *Note: Please do not write in shaded    
  areas.*                                 
  --------------------------------------- -------------------------------