Exit this survey Superhero Hustle - Oct. 31, 2016 Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Gender Male Female Other Question Title * 4. Please indicate faculty or staff. Faculty Staff Other (please specify) Question Title * 5. Please enter your 9-digit staff ID # (found on your BruinCard): Question Title * 6. Department Question Title * 7. Email Question Title * 8. T-shirts available for pick up at the John Wooden Center or Kinross Recreation Center at the completion of the Superhero Hustle walk (while supplies last). Participation stamp card required to redeem t-shirt. Please indicate which location you plan to pick up your t-shirt at: John Wooden Center Kinross Recreation Center Question Title * 9. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/join Yes No Question Title * 10. Are you currently signed up for MoveMail? If not, click here to get moving everyday with our daily MoveMails! Yes No Question Title * 11. In order to complete your registration, Please read the following waiver HERE and indicate below you have read and understood this document. The following questions 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 * 12. 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 * 13. 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 * 14. Over the past week, have many times have you engaged in any type of physical activity for more than 30 minutes? (walking, gardening, cleaning, etc.) 1 or Less 2-5 6 or More Question Title * 15. 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. I have had a healthy lifestyle for years. Question Title * 16. Which of the following FITWELL programs have you participated in? Check all that apply. FIT Sports Bruin Health Improvement Program (BHIP/BHIP.5) FITWELL Edu (fitness education at your department work site) FitZone Classes FitBreaks Warm Up to Work BruinMind Fit Chair Massage Personal Fitness Training Have not participated in FITWELL Programs Other, please specify: Register
