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* 1. Student ID# (If used at your school)

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* 2. First Name

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* 3. Last Name

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* 4. Teacher's Last Name

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* 5. What is the name of your school?

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* 6. What is your age?

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* 7. What is your gender?

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* 8. What grade are you in?

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* 9. What is your Ethnicity? (Please choose the ONE that best describes you)

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* 10. Experts recommend that children should be physically active for at least how many minutes per day?

For the following set of questions, there is NO right answer. Read all of the answers and pick the one that best answers the question for you. Remember that there is not a right answer and we want you to be as honest as possible. 

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* 11. How do you feel about eating fruits?

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* 12. How do you feel about eating vegetables?

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* 13. How do you feel about drinking water instead of pop/soda/juice/sports drinks?

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* 14. How do you feel about eating snacks that are healthy?

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* 15. Yesterday, did you eat any vegetables or salad?
(Examples: carrots, squash, sweet potatoes, salad made with lettuce, or any green vegetables like spinach, lettuce, green beans, broccoli, peppers, tomatos, eggplant)

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* 16. Yesterday, did you eat fruit? Fruits are all fresh, frozen, canned, or dried fruits. Do not count fruit juice. 

For the following set of questions there is no right answer. Read all of the answers and pick the one that best answers the question for you. Remember, that there is not a right answer and we want you to be as honest as possible. Physical activity is a general word used to describe movement activities such as sports, games, exercise, walking to and from places, or doing chores at home. 

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* 17. Physical Activity is fun for me

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* 18. Physical Activity is a valuable part of my life

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* 19. I find physical activity exciting

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* 20. I think it is useful to my health to be physically active

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* 21. I do not like to be physically active.

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* 22. Physical activity helps me in a lot of different ways.

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* 23. I think physical activity is pretty boring.

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* 24. It is important to be physically active.

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* 25. I feel happy when I am physically active.

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* 26. I think physical activity is important to do everyday.

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* 27. I have a lot of positive feelings when I do physical activity.

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* 28. Physical activity is not very useful to me.

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* 29. I like to do physical activity almost everyday.

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* 30. It is not important to me to be physically active.

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* 31. I do not have much fun when I am being physically active.

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* 32. Physical activity is important for my health.

For the following set of questions there is no right answer. Read all of the answers and pick the one that best answers the question for you. Remember that there is not a right answer and we want you to be as honest as possible.

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* 33. How much does your parents or the adult that takes care of you, encourage you to do physical activity?

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* 34. How much does your parents or the adult that takes care of you, do a physical activity with you?

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* 35. How much does your parents or the adult that takes care of you, watch you take part in physical activity?

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* 36. How much does your parents or the adult that takes care of you, talk with you about your physical activity?

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* 37. How much does your parents or the adult that takes care of you, provide transportation so you can go to a place where you can do physical activities/sports?

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* 38. How much does your teacher, encourage you to do physical activity?

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* 39. How much does your teacher, do physical activity with you?

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* 40. How much does your teacher, watch you take part in physical activity?

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* 41. How much does your teacher talk with you about your physical activity?

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* 42. How much does your school classmates and friends, encourage you to do physical activity?

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* 43. How much does your school classmates and friends, do physical activity with you?

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* 44. How much does your school classmates and friends, watch you take part in physical activity?

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* 45. How much does your school classmates and friends talk with you about your physical activity?

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* 46. During the PAST 7 DAYS, how many days did you exercise or take part in physical activity for AT LEAST 60 MINUTES per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)

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* 47. During the PAST 7 DAYS, how many days did you exercise or take part in physical activity that MADE YOUR HEART BEAT FAST AND MADE YOU BREATHE HARD FOR AT LEAST 20 MINS? (For example, basketball, soccer, running or jogging, fast dancing, swimming laps, tennis, fast bicycling, or similar aerobic activities.)

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* 48. During the PAST 7 DAYS how many days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?

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* 49. On an average SCHOOL day, how many hours do you spend in front of a TV, computer, smart phone, or other electronic device watching shows or videos, playing games, accessing the Internet, or using social media (also called "screen time")? (Do not count time spent doing schoolwork.)

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* 50. On an average SCHOOL day, how many hours do you spend in front of a computer, smart phone, or other electronic device or accessing the Internet (also called "screen time") for school work?

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* 51. On an average WEEKEND day, how many hours do you spend in front of a TV, computer, smart phone, or other electronic device watching shows or videos, playing games, accessing the Internet, or using social media (also called "screen time")? (Do not count time spent doing schoolwork.)

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* 52. When you are in class during the day, how many times per day do your teachers offer you a physical activity or brain break?

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* 53. I PLAN to do sports and exercise that make me breathe hard outside of school in the next TWO weeks.

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* 54. I INTEND to do sports and exercise that make me breathe hard outside of school in the next TWO weeks.

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* 55. I EXPECT to do sports and exercise that make me breathe hard outside of school in the next TWO weeks.

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* 56. Have you heard of the I Paʻa Ka Huewai Pawehe Grant?

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* 57. I have participated in physical education (gym) class this year.

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