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Tackling Inactivity in Colleges
The Live Well, Learn Well Project

The reason for this survey is to develop enrichment opportunities, within the College, for Students to take part in.

To help analysis the data survey responses are then uploaded to Upshot and made anonymous.

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* 1. Student Name & Student M Number

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* 2. In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?
(This may include sport, exercise, brisk walking or cycling for recreation or to get to and from places, but should not include homework or physical activity that may be part of your job.)

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* 3. Please answer both questions below, only selecting one response for each question.
 
(3a) I can achieve most of the goals I set myself?

(3b) Most people in your area can be trusted?

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* 4. Please answer each question below, only selecting one response for each question.

(4a) I have been feeling optimistic about the future?

(4b) I have been feeling useful?

(4c) I have been feeling relaxed?

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* 5. Please answer each question below, only selecting one response for each question.

(5a) I have been dealing with problems well?

(5b) I have been thinking clearly?

(5c) I have been feeling close to other people?

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* 6. I have been able to make up my own mind about things?

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* 7. Do you have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more?

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* 8. If any, please list below which sports and/or activities you would be most interested in taking part in.

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* 9. Student Consent (PLEASE TICK)

It is important to note that you have the right to withdraw your consent at any point.

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* 10. Date Completed:

Date

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