Student Information Section

To be administered to students before participation in the UCLA Health SOUND BODY SOUND MIND Curriculum.

***Students, please note: This survey is COMPLETELY confidential and will not be shared with your teacher or anyone else at your school. Please answer the questions honestly and to the best of your knowledge.

What school do you attend?

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* 1. What school do you attend?

What grade are you in?

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* 2. What grade are you in?

What is your gender

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* 3. What is your gender

What is your Race/Ethnicity?

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* 4. What is your Race/Ethnicity?

Would you characterize yourself as:

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* 5. Would you characterize yourself as:

How many times do you exercise or play sports per week?

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* 6. How many times do you exercise or play sports per week?

Are you comfortable participating in P.E. activities?

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* 7. Are you comfortable participating in P.E. activities?

How many sodas on average do you drink?

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* 8. How many sodas on average do you drink?

How many times on average do you eat fast food?

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* 9. How many times on average do you eat fast food?

How many servings of fruits and vegetables should you eat every day?

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* 10. How many servings of fruits and vegetables should you eat every day?

How much water should you drink every day?

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* 11. How much water should you drink every day?

Which of these is not one of the 5 food groups?

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* 12. Which of these is not one of the 5 food groups?

To maintain a healthy lifestyle, how many minutes should you exercise every day?

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* 13. To maintain a healthy lifestyle, how many minutes should you exercise every day?

During a workout, your heart rate should be between what percent of its maximum heart rate?

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* 14. During a workout, your heart rate should be between what percent of its maximum heart rate?

Does your new fitness center motivate you to exercise more?

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* 15. Does your new fitness center motivate you to exercise more?

Comparing your fitness level now and before you started using your new fitness center, would you say that you are now:

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* 16. Comparing your fitness level now and before you started using your new fitness center, would you say that you are now:

Are you more knowledgeable about fitness and exercise than when you started working out in the UCLA Health Sound Body Sound Mind fitness center?

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* 17. Are you more knowledgeable about fitness and exercise than when you started working out in the UCLA Health Sound Body Sound Mind fitness center?

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