Register for the The Mount Kilimanjaro
Take the Stairs Challenge!

Winter 2020

To register for The Mount Kilimanjaro Take the Stairs Challenge, please take a few minutes to complete this survey:

Question Title

1. Please provide the following information: (Required.)

Name:

Uni:

Columbia University Email:

Question Title

2. Please indicate the extent you agree or disagree with the following statement:
I want to join The Mount Kilimanjaro Take the Stairs Challenge in order to...

	Strongly Agree	Agree	Disagree	Strongly Disagree
Manage my weight	Manage my weight Strongly Agree	Manage my weight Agree	Manage my weight Disagree	Manage my weight Strongly Disagree
Increase my energy level	Increase my energy level Strongly Agree	Increase my energy level Agree	Increase my energy level Disagree	Increase my energy level Strongly Disagree
Improve my fitness level	Improve my fitness level Strongly Agree	Improve my fitness level Agree	Improve my fitness level Disagree	Improve my fitness level Strongly Disagree
Feel more healthy	Feel more healthy Strongly Agree	Feel more healthy Agree	Feel more healthy Disagree	Feel more healthy Strongly Disagree
Feel more positive	Feel more positive Strongly Agree	Feel more positive Agree	Feel more positive Disagree	Feel more positive Strongly Disagree

Other (please specify)

Question Title

3. In the past month, how often did you choose the stairs over the elevator while you were at work?

Never

Rarely (less than once a week)

Sometimes (once a week or more)

Often (once a day or more )

Varies

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4. Team Registration Information: (Remember, there are 4-5 participants per team; if you have not identified a team, please leave this section blank and you will be assigned to a team)

What is your team name?

What is the name of your team captain? If you are the captain, write your own name.

Question Title

5. Please share any comments below:

Thank you! Best of luck in The Mount Kilimanjaro Take the Stairs Challenge!

For questions or comments please contact Daniela Elazari, Wellness Manager, at dn2384@columbia.edu.

Question Title

* 1. Please provide the following information: (Required.)

Question Title

* 2. Please indicate the extent you agree or disagree with the following statement:I want to join The Mount Kilimanjaro Take the Stairs Challenge in order to...

Question Title

* 3. In the past month, how often did you choose the stairs over the elevator while you were at work?

Question Title

* 4. Team Registration Information: (Remember, there are 4-5 participants per team; if you have not identified a team, please leave this section blank and you will be assigned to a team)

Question Title

* 5. Please share any comments below:

1. Please provide the following information: (Required.)

2. Please indicate the extent you agree or disagree with the following statement:
I want to join The Mount Kilimanjaro Take the Stairs Challenge in order to...

3. In the past month, how often did you choose the stairs over the elevator while you were at work?

4. Team Registration Information: (Remember, there are 4-5 participants per team; if you have not identified a team, please leave this section blank and you will be assigned to a team)

5. Please share any comments below: