This report describes the results from the first Global School-based Student Health Survey (GSHS) conducted in the Cook Islands by the Ministry of Health and Ministry of Education from 27 July – 5th November 2010. The Cook Islands is a nation comprise of 15 islands spread over 2 million square kilometer in the Polynesian Triangle of the South Pacific, with an estimated population of 17,794 (Cook Islands Census 2011. The population is dispersed across the islands but concentrated on Rarotonga (73.65), the centre of governance and commerce. The Cook Islands has been a self-governing nation in free association with New Zealand since 1965. The Cook Islands is governed by a Prime Minister who is the leader of the majority party in the legislature, the legislature is elected by popular vote. Since 2003, Ministries of Health and Education around the world have been using the GSHS to periodically monitor the prevalence of important health risk behaviors and protective factors among students. To date over 45 countries have completed the GSHS.