Middle and High School Wellness Survey

Please complete this survey honestly and accurately to help us best understand the activity level and eating habits of our students.  The results of this survey will be confidential.  Your unique responses will not be traced to you.  

The survey is an important part of us understanding our students and in helping us identify needs that could bring much needed resources to the school to help improve our physical education and fitness programs.  

Thank you in advance for your help.

Question Title

* 1. I am in:

Question Title

* 2. I am a:

Question Title

* 3. Which best describes you as a student?

Question Title

* 4. Yesterday, did you eat any vegetables?  
Vegetables are salads; boiled, baked and mashed potatoes; and all cooked and uncooked vegetables.
Do not count French fries or chips. 

Question Title

* 5. Yesterday, did you eat fruit?  
Do not count fruit juice

Question Title

* 6. On how many of the last seven days did you exercise or participate in activities that accelerated your heart rate and made you breathe hard for at least 60 minutes.  (For example:  basketball, jogging, skating, dancing, swimming laps, tennis, fast bicycling, or aerobics)?

Question Title

* 7. How many hours each day do you usually watch TV, play video games, or use a  computer, tablet, or phone?

Question Title

* 8. In the past week, how many times did you eat out at restaurants?

Question Title

* 9. Did you eat breakfast this morning?

Question Title

* 10. Which best describes the breakfast you ate this morning?

Question Title

* 11. I usually eat breakfast...

Question Title

* 12. In the last 7 days, on how many days did you do sports, dance, or play games in which you were very active after school?

Question Title

* 13. Which one of the following describes you best for the last 7 days? 
Read all five statements before deciding on the one answer that best describes you.

Question Title

* 14. I would be interested in the school having more opportunities to be active before school, after school, and on the weekend.

Question Title

* 15. What suggestions would you have for new or expanded fitness activities?

Question Title

* 16. I would be interested in learning more about how my food choices can help me stay healthy.

T