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* 1. First Name

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* 2. Last Name

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* 3. Gender

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* 4. Please indicate faculty or staff.

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* 5. Please enter your 9-digit Bruin ID # (found on your BruinCard):

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* 6. Department

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* 7. Email

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* 8. How did you find out about the UC Food Day Learn at Lunch?

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.

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* 9. On average, how would you describe your energy level?

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* 10. On average, how would you rate your ability to cope with daily stress?

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* 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.)

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* 12. In which of the following categories would you place yourself?

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