Fillable Questionnaire (Southeastern Louisiana University)

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Questionnaire (Southeastern Louisiana University)

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The Questionnaire (Southeastern Louisiana University) form is 2 pages long and contains:

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  • 7 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

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Questionnaire
Name: __________________________________ Date: ______________
W Number: ______________________________
Classification: ____________________________
How many hours are you taking this semester? ________
Are you a commuter or do you live on campus? ______________________
If you are a commuter, how far away do you live? ______________
For commuters, how willing are you to stay on campus to participate in L.U.L?
1 2 3 4 5 6 7 8 9 10
Not motivated at all Very motivated
Do you work? _____________ On campus or off campus? ___________
How many hours a week do you work? _________
Do you have a device that tracks your steps/physical activity (Apple Watch, FitBit, other)? _____
Please circle the following that apply to you.
Currently taking medications
Currently taking drugs that are not prescribed to you
Currently using tobacco products (vape, smokeless, etc.)
Consume caffeine
Have been diagnosed with a medical condition such as heart disease, diabetes, PCOS,
ets.
Have physical limitations
Other __________________________________________________________________
If you circled “currently taking medications,” please list the medications you are taking.
______________________________________________________________________________
If you circled “have been diagnosed with a medical condition,” please list the condition(s).
______________________________________________________________________________
If you checked “have physical limitations,” please list the physical limitation(s).
______________________________________________________________________________
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Questionnaire (Southeastern Louisiana University)

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Completed 20 July 2020

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