Healthy Places, Healthy People: Working Together to make Austin/Travis County Healthier

10-WEEK CHALLENGE AWARD FORM

Your information is treated strictly confidential.

Congratulations on completing the 10-Week Challenge!

To receive your award, please answer the questions below. If you are not completing this form on-line, please mail it to us at:

Austin Public Health – 10-Week Challenge * PO BOX 1088 * Austin, TX 78767-1088

WALK TX 10-WEEK CHALLENGE AWARD FORM

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Name*
PLEASE COMPLETE THE 10-QUESTION SURVEY ABOUT YOUR 10-WEEK CHALLENGE
All survey responses are reported together as aggregate data, used for program evaluation only. Program evaluation is an important process that measures program effectiveness. It informs us of how we can improve the program. Thank you for your feedback.
1. On average, how many days per week do you now engage in at least 30 minutes of exercise that increases your heart rate and makes you sweat?*
2. How active are you now, compared to your physical activity level before participating in the WALK TX AND MORE 10-Week Challenge.*
3. What types of physical activity do you engage in now? (Choose all that apply.)*
4. Have you noticed any health benefits from participating in this program?*
5. Was it difficult to track your activities and tally points?*
6. Was it helpful to have a Group Leader, if you were in a group?*
7. Overall, how would you rate your experience as a participant in the 10-Week Challenge?*
8. Since taking the Challenge, do you have more support to stay active in any of the following ways? (Choose all that apply.)*
9. May we use your survey comments for promotions or reports with your:*
10. Medal Earned
This field is for validation purposes and should be left unchanged.
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