Post Completion Survey

To receive your canvas book bag, you must submit this form by 6-20-12. Thanks for your feedback!
LAST NAME

Month, date and year of birth as mm/dd/yy
1. Were you able to complete all 8 weeks of the program?

Yes No
If not, please select the main reason (please select one)
Illness/injury Travel/vacation
Didn't have time Lost interest Joined late Did complete

2. ADULTS: Since taking part in this program, how many days per week are you fitting in moderate physical activity (e.g. brisk walking, bicycling) for at least 30 minutes?
None 1 2 3 4 5 6 7

CHILDREN (18 or younger): Since taking part in this program, how many days per week are you getting moderate physical activity (e.g. brisk walking, bicycling) for a total of 60 minutes?
None 1 2 3 4 5 6 7

3. Did you find the weekly health e-mails useful? Yes No

4. Did you participate in any of the onsite library programs? Yes   No

5. If offered again, would you participate in a similar program at the library? Yes   No



Click submit to complete the survey.