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1. First Name (Required.)

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2. Last Name (Required.)

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3. Please indicate your UCLA affiliation: (Required.)

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4. Please enter your 9-digit staff ID # (found on your BruinCard): (Required.)

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5. Department (Required.)

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6. Gender

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7. Email (used for event updates and to contact prize winners by Friday May 22) (Required.)

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8. Which walking location do you plan to attend? (Required.)

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9. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/newmembers

Questions 10-14 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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10. On average, how would you describe your energy level?

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

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12. Number of times you have engaged in any type of physical activity for more than 30 minutes for the past week? (walking, gardening, cleaning, etc.)

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

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14. Which of the following FITWELL programs have you participated in? Check all that apply. (Required.)

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