"Making Healthy Choices" Survey

MTP-POWER 10 Candidate Coach, please use this form to report your weekly "Making Healthy Choices" goals and achievements! This report should be completed after each workshop session.

Remember to email each week a "Making Healthy Choices" photo and/or video to info@missteenpromise.com


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* 1. WHAT IS YOUR NAME AND MTP-POWER 10 FAN CLUB NAME?

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* 2. WHAT DATE  AND TIME DOES THIS REPORT REPRESENT?

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* 3. POSITIVE ZONE:  FROM THE WORKSHOP SESSION, WHAT INFORMATION AREA(S) INTEREST YOU THE MOST? (Check All That Apply)

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* 4. POISED ZONE: WHAT TWO SPECIFIC THINGS DID YOU LEARN FROM THE "MAKING HEALTHY CHOICES" WORKSHOP?

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* 5. PRODUCTIVE ZONE: THIS WEEK, WHAT PERSONAL S.M.A.R.T. GOAL DID YOU CREATE?

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* 6. PROFESSIONAL ZONE: HOW DID YOU SHARE "MAKING HEALTHY CHOICES" INFORMATION YOU LEARNED FROM THE MTP WORKSHOP WITH YOUR FAN CLUB?

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* 7. ME & MOM FUN: WHAT "MAKING HEALTHY CHOICES" FUN DID YOU AND MOM COMPLETE? HOW MUCH TIME DID YOU SPEND DOING IT? HOW MANY DAYS? (Check All That Apply)

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* 8. DISCOVERY ZONE: WHAT HAVE YOU LEARNED THAT COULD HELP OTHERS?

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* 9. SUPPORT TEAM: WHO ARE THE OFFICERS & MEMBERS OF YOUR MTP-POWER 10 FAN CLUB?

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* 10. I certify that my answers are true and complete to the best of my knowledge. I will email info@missteenpromise.com  a photo and/ or video that supports this weekly survey report of me meeting with my "MTP POWER 10 FAN CLUB" and/or "ME & MOM" Exercise Fun.  

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