Independent Study Health/P.E. Survey

Preliminary Survey

As part of a masterís degree program at California State University, Sacramento, we are studying the effectiveness of using technology in independent study physical education courses. Your honest responses and timely return of this survey will help us understand the needs of our students and how a program might be structured to best meet their needs.

Read each statement carefully, and indicate your level of agreement by circling the appropriate number in the columns on the right. Please respond to all of the statements!

  1. On how many of the past seven days did you exercise or participate in physical activity for at least 20 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities?

A. 0 days†† B. 1 day†††††††††† C. 2 days†††††††† D. 3 days†††††††† E. 4 days††††††††† F. 5 days††††††††† G. 6 days

  1. On how many of the past seven days did you exercise or participate in physical activity for at least 30 minutes that did not make you sweat and breathe hard, such as fast walking, bicycling, skating, pushing a lawn mower, or mopping floors?

A. 0 days†† B. 1 day†††††††††† C. 2 days†††††††† D. 3 days†††††††† E. 4 days††††††††† F. 5 days††††††††† G. 6 days

  1. On how many of the past seven days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?

A. 0 days†† B. 1 day†††††††††† C. 2 days†††††††† D. 3 days†††††††† E. 4 days††††††††† F. 5 days††††††††† G. 6 days

  1. On an average school day, how many hours do you watch TV?
    1. I do not watch TV on an average school day
    2. Less than 1 hour per day
    3. 1 hour per day
    4. 2 hours per day
    5. 3 hours per day
    6. 4 hours per day
    7. 5 or more hours per day
  1. On an average school day, how many hours do you play videogames?
    1. I do not play videogames on an average school day
    2. Less than 1 hour per day
    3. 1 hour per day
    4. 2 hours per day
    5. 3 hours per day
    6. 4 hours per day
    7. 5 or more hours per day
  1. On an average school day, how many hours do you use a computer?
    1. I do not use a computer on an average school day
    2. Less than 1 hour per day
    3. 1 hour per day
    4. 2 hours per day
    5. 3 hours per day
    6. 4 hours per day
    7. 5 or more hours per day
  1. In an average school week, how many days do you do physical education?

A. 0 days†††††††† B. 1 day†††††††††† C. 2 days†††††††† D. 3 days†††††††† E. 4 days††††††††† F. 5 days†††††††††

  1. In the past 12 months, on how many sports teams did you play (include any run by your school or community groups)?

A. 0 teams††††††† B. 1 team†††††††† C. 2 teams †††††† D. 3 or more teams††††††

  1. During the past 12 months, how many times were you injured while exercising, playing sports, or being physically active and had to be treated by a doctor or a nurse.

A. 0 times†††††††† B. 1 time††††††††† C. 2 times ††††††† D. 3 times†††††††† E. 4 times†††††††† F. 5 or more times

Please add any comments you have in response to the following questions.

What three things did you like about independent study?

(1.)

(2)

(3)


What are three (3) things you would change your schoolís physical education program?

(1)

(2)

(3)

For each item, please check the description that applies to you.

 


Year in school

††††††††††††††† [1] 9th grade†††††††††††††††††††††††††††††††††††††† [3] 11th grade†††††††††††††††††††††††††††††††††††††††

††††††††††††††† [2] 10th grade††††††††††††††††††††††††††††††††††† [4] 12th grade

 


Female/Male

††††††††††††††† [1] Female††††††††††††††††††††††††††††††††† [2] Male

 


Ethnicity:

††††††††††††††† [1] African American††††††††††††††††††††††††††††††††††††††††† [3] Asian/Pacific Islander

††††††††††††††† [2] Caucasian†††††††††††††††††††††††††††††††††††††††††††††††††††††† [4] Latino/Hispanic

††††††††††††††† [5] Other (please state) _________________________

 


School you attend† ________________________________________________