Exit this survey UC Walks - May 18,2016 Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Please indicate your UCLA affiliation: Faculty Staff Retiree Postdoc Resident/Fellow Campus Leadership (Chancellor, Vice Chancellor, Director, etc.) Other Other (please specify) Question Title * 4. Please enter your 9-digit staff ID # (found on your BruinCard): Question Title * 5. Department Question Title * 6. Gender Female Male Other Question Title * 7. Email (used for event updates and to contact prize winners by Friday May 20) Question Title * 8. Which walking location do you plan to attend on 5/18 from 12-1p? Main Campus - Wilson Plaza RR Medical Center - Westwood Blvd turnaround Santa Monica Hospital FPG/LAX University Apartments North/South Question Title * 9. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/newmembers Yes No Questions 10-14 are optional, however these questions are geared toward collecting data that will help to develop and improve FITWELL Programs for Faculty and Staff. Responses are confidential and will not be shared. Question Title * 10. On average, how would you describe your energy level? Not Energized Slightly Energized Somewhat Energized Energized Very Energized Not Energized Slightly Energized Somewhat Energized Energized Very Energized Question Title * 11. On average, how would you rate your ability to cope with daily stress? Very high High Medium Low Very low Very high High Medium Low Very low Question Title * 12. Number of times you have engaged in any type of physical activity for more than 30 minutes for the past week? (walking, gardening, cleaning, etc.) 1 or Less 2-3 4-5 6 or More Question Title * 13. In which of the following categories would you place yourself? I'm not interested in pursuing a healthy lifestyle. I have been thinking about changing some of my health behaviors. I am planning on making a health behavior change within the next 30 days. I have made some health behavior changes, but I still have trouble following them/am still in the process of implementing them. I have had a healthy lifestyle for years. Question Title * 14. Which of the following FITWELL programs have you participated in? Check all that apply. FIT Sports Bruin Health Improvement Program (BHIP/BHIP.5) BruinMindFit FITWELL Edu (fitness education at your department work site) FitZone Classes (free Tai Chi & Qi Gong, Total Body Strength, Yoga) Chair Massage Personal Fitness Training None of the above Other, please specify: Question Title * 15. Please type full name below once waiver here has been read. I understand my signature is being transferred electronically, and I will not challenge the validity of the signature in any legal proceeding in which this document may be offered or used. Submit