Background: Insufficient attention has been paid to the process of conducting the Centers for Disease Control and Prevention's School Health Index (SHI) to promote collaboration between universities and urban school districts when developing adolescent health promotion initiatives. This article provides an overview of the real-world contextual challenges and opportunities this type of collaboration can pose. Methods: The SHI and selected collaboration principles were used to facilitate partnership and increase stakeholder buy-in, which led to developing and implementing an 8-year health promotion campaign. Results: The focus on planning brought together key stakeholders to allow for health promotion programming to take place, despite the competing demands on the schools. The SHI allowed for input from stakeholders to develop campaign activities and inform school- and district-wide policy. Universities and school districts desiring to develop and implement school-based, adolescent health promotion programs should (1) identify the hierarchical structure of the school district, (2) establish credibility for the program and the university staff, (3) emphasize the benefits to all partners, (4) maintain a cooperative partnership with teachers and administrators, (5) appreciate the need for planning, and (6) provide as many resources as possible to aid an already overburdened school system. Conclusions: Promoting healthy behaviors among students is an important part of the fundamental mission of schools. The significance of collaboration using the SHI, with direct input from students, teachers, administrators, and university partners, is critical in the development of institutional support for implementation of adolescent health promotion initiatives. (Contains 2 tables.)