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Please fill out the following survey as honestly as you can. There are no right or wrong answers. Do not put your name on the survey.
Download the
Girls In Motion Pre-Survey
 or complete the form below.
Step
1
of
4
25%
Girls in Motion Pre-Activity Survey
In the last 7 days, did you do sports, dance of play games in which you were very active Right After School?
None
One Time
2-3 Times
4-6 Times
Every Day
In the last 7 days, did you play sports, dance or play games in which you were very active in the Evenings?
None
One Time
2-3 Times
4-6 Times
Every Day
This past weekend, how many times did you play sports, dance or play games in which you were very active?
None
One Time
2-3 Times
4-6 Times
Every Day
On Average, how many hours of television do you watch between the time you come home from school and the time you go to bed?
<1 Hour
1-2 Hours
3-4 Hours
>4 Hours
IN General, I like the way I am
False
Mostly False
Sometimes False/Sometimes True
Mostly True
True
Overall, I have a lot to be proud of
False
Mostly False
Sometimes False/Sometimes True
Mostly True
True
A lot of things about me are good
False
Mostly False
Sometimes False/Sometimes True
Mostly True
True
When I do something I do it well
False
Mostly False
Sometimes False/Sometimes True
Mostly True
True
I like the way I look
False
Mostly False
Sometimes False/Sometimes True
Mostly True
True
I like being a girl
Never
Sometimes
Most of the Time
Always
When it comes to be physically active, I can be a role model to other girls my age
Never
Sometimes
Most of the Time
Always
I am interested in participating in recreational physical activities
Never
Sometimes
Most of the Time
Always
If you answered Never or Sometimes to the question above, check as many of the answers that apply.
I don't like physical activity
I feel embarrassed in front of my friends
I don't know whats available
I can't afford to participate
Other
Please Explain
If you answered Most of the Time or Always, mark as many of the answers below that apply.
My parents support me in my involvement
My friends are involved in the activities
I am good at recreational physical activities
I feel good when I participate in recreational physical activities
Other
Please Explain
I can fit physical activity into my life each day
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
When I spend time with friends, we do physical activities together
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
I can find recreational activities in my community that I enjoy
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
I can be a leader among my friends promoting physical activity
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
I can be physically fit
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
I can maintain a healthy weight
Not at all confident
A little bit confident
Somewhat confident
Quite confident
Very confident
I know how to find out what recreational activities are available in my community
No knowledge
Some knowledge
Quite a bit of knowledge
A lot of knowledge
It is important for me to by physically active every day
Not at all important
Somewhat important
Quite important
Very important
For physical activities, do you prefer
Girls only activities
Mixed/co-ed activities
How old are you?
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