Earth Day Learn at Lunch - April 22, 2015 Question Title * 1. First Name (Required.) Question Title * 2. Last Name (Required.) Question Title * 3. Gender (Required.) Male Female Other Question Title * 4. Please indicate faculty or staff. (Required.) Faculty Staff Student Other (please specify) Question Title * 5. Please enter your 9-digit Bruin ID # (found on your BruinCard): Question Title * 6. Department Question Title * 7. Email (Required.) Question Title * 8. How did you find out about the Earth Day Learn at Lunch? Email Flyer UCLA Recreation Website Word of Mouth Other, please specify Questions 9-12 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 * 9. 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 * 10. 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 * 11. 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 * 12. 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. Submit