JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Community Health & Wellness Survey
Hello! Thank you for participating in our survey. Please answer each question honestly.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1. First & Last Name (optional, but required for student extra credit)
Your answer
2. Gender:
*
Male
Female
Prefer not to say
3. Grade Level:
*
6th
7th
8th
high school
college
Out of school
Other:
4. How often do you think about your health?
*
Daily
Never
Yearly
Weekly
Monthly
Other:
5. Which part of your health do you think is most important?
*
Physical health (exercise)
Mental health (stress and disorders)
Emotional health (depression)
Nutritional health (what you eat)
Other:
6. How would you rate your current overall health and wellness?
*
Needs improvement
1
2
3
4
5
6
7
8
9
10
Super healthy!
7. During quarantine, how do you "watch what you eat"? (Check all that apply).
*
Eat less junk food (salty, fried, high-fat foods).
Eat more fruits and vegetables.
Reduce my sugar intake (consume less sweets and candy).
Drink more water.
Eat more fish and chicken instead of red meat (like beef).
Avoid sugary drinks like soda, juices and flavored drinks like Frappuccinos.
Take vitamins and supplements.
I don't watch what I eat.
Other:
Required
8. During quarantine, what type of exercise do you participate in? (Check all that apply).
*
Team sports (soccer, basketball, volleyball, football, boxing etc.)
Solo sports (golf, racquetball, biking, hiking, walking, etc.)
Go to the gym or use your home gym equipment
Yoga/stretching
I don't exercise.
Other:
Required
9. When you are "stressed out" or upset, what do you do to reduce your stress? (Check all that apply).
*
Take a hot bath or shower
Exercise
Talk to a friend
Listen to music
Ask an adult for help
Use aromatherapy or essential oils
Meditation
Other:
Required
10. True or False? I think that "health and wellness" is more important to people over 20 years old than to students in middle or high school?
*
True
False
11. True or False? I think it's harder to be healthy during the quarantine.
*
True
False
12. How would you like to see "health and wellness" addressed in schools?
*
A healthy cooking club
Yoga instruction
Guided meditation classes
Have a school assembly on the topic
Zumba class
Virtual field trips
Other:
Required
13. Extra credit question: Please give us a quote! In your own words and in a complete sentence (or more), tell us why we should all be concerned about the health and wellness of students in our community...
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Palmdale School District.
Report Abuse
Forms
