fitness

5. What is the most important thing for you to change at this time in your life?

A value is required.

6. What prompted you to apply to the Biggest Loser program?

A value is required.

7. Who among your friends and family would be a daily support?

A value is required.

8a. Which best reflects how ready you were 6 months ago to change the behaviors that prompted you to apply to the Biggest Loser program? Select Not ready to change Thinking of changing Undecided Somewhat ready Very ready Please select a valid item.

8b. Which best reflects how ready you are at the present time to change the behaviors that prompted you to apply to the Biggest Loser program? Select Not ready to change Thinking of changing Undecided Somewhat ready Very ready Please select a valid item.

8c. How did you get from a to b?

A value is required.

9. Is there currently anything physical keeping you from participating in exercise? If yes, describe. No Yes

10a. How many times per week do you exercise? If none, go to question 11.

10b. What types of exercises do you engage in?

A value is required.

11. What did you like and dislike about the exercises you have tried?

A value is required.

12. How would you describe your current eating habits? How many meals per day? Breakfast?

A value is required.

13. Have you ever seriously tried to diet? If yes, describe. No Yes

14. Are you currently taking any vitamin or nutritional supplements? If yes, please describe. No Yes

15. How many pieces of fresh or frozen fruit do you eat each day? (a portion based on ½ cup) Select More than 3 1 - 3 1 or less Please select a valid item.

16. How many portions of fresh or frozen vegetables do you eat each day? (a portion based on ½ cup) Select More than 7 4 - 7 2 - 4 1 or less Please select a valid item.

17. Do you drink caffeine? If yes, how may portions? (1 portion = 1 cup) No Yes  

18. Where do you eat most often? Select Home Fast Food Sit-down restaurants Work Other Please select a valid item.

19. What are your favorite types of food?

A value is required.

20. What do you find yourself craving?

A value is required.

21. How many glasses of water do you drink per day? Select 0 - 2 3 - 5 6 - 8 9 -12 Please select a valid item.

22. How many soft drinks do you drink per day? Select 0 - 2 3 - 5 6 - 8 9 -12 Please select a valid item.

23. How many meals and/or snacks do you have per day?

A value is required.

24. Do you feel you eat healthy most of the time? No Yes

---

The next few questions refer to alcohol use.  The following is a way to think of different drinks.
      1 drink = one 12oz can/bottle of regular beer
                  = one 5 oz glass of regular (12 %) wine
                  = 1 ½ oz of liquor (rum, whiskey, vodka)

25. How often do you have a drink containing alcohol? Select Never Monthly or less 2-4 times/month 2-3 times/week 4 or more times/week Please select a valid item.

26. How many drinks containing alcohol do you have on a typical day when you are drinking? Select Never 1-2 3-4 5-6 7-9 10 or more Please select a valid item.

27. How often do you have 5 or more drinks on one occasion? Select Never Less than monthly Weekly Daily or almost daily Please select a valid item.

28. When you do drink alcohol, what % of the time from 0% to 100% do you also smoke cigarettes?%

29. Have you ever smoked cigarettes?

No (if No, skip to question 33) Yes

30. Do you currently smoke cigarettes? No Yes; for how long

31. Do you feel cutting back on your alcohol consumption might help you stop smoking? No Yes

32. How many cigarettes do you smoke per day?

---

33. Please read each item and then indicate using the following scale the feeling you experience for each.

1 Strongly Agree

2 Agree

3 Disagree

4 Strongly Disagree

I feel that I am a person of worth, at least on an equal plane with others.	Select 1 2 3 4 Please select a valid item.
I feel that I have a number of good qualities.	Select 1 2 3 4 Please select an item.
All in all, I am inclined to feel that I am a failure.	Select 1 2 3 4 Please select an item.
I am able to do things as well as most other people.	Select 1 2 3 4 Please select an item.
I feel that I have much to be proud of.	Select 1 2 3 4 Please select an item.
I take a positive attitude about myself.	Select 1 2 3 4 Please select a valid item.
On a whole I am satisfied with myself.	Select 1 2 3 4 Please select a valid item.
I wish I could have more respect for myself.	Select 1 2 3 4 Please select an item.
I certainly feel useless at times.	Select 1 2 3 4 Please select a valid item.
At times, I think I am no good at all.	Select 1 2 3 4 Please select a valid item.

---

34. Please read each item and then indicate using the following scale the feeling you experience for each.
1 Not At All	2 Slightly	3 Moderately	4 Very	5 Extremely Characteristic

I wish I wasn't so uptight about my physique/figure.	Select 1 2 3 4 Please select a valid item.
There are times when I am bothered by thoughts that other people are evaluating my weight or muscular development negatively.	Select 1 2 3 4 Please select a valid item.
Unattractive features of my physique/figure make me nervous in certain social settings.	Select 1 2 3 4 Please select a valid item.
In the presence of others, I feel apprehensive about my physique/figure.	Select 1 2 3 4 Please select a valid item.
I am comfortable with how fit my body appears to others.	Select 1 2 3 4 Please select a valid item.
It would make me uncomfortable to know others were evaluating my physique/figure.	Select 1 2 3 4 Please select a valid item.
When it comes to displaying my physique to others, I am a shy person.	Select 1 2 3 4 Please select a valid item.

---

35. Do you mind waiting for others to finish their work?

Always  Sometimes  Occasionally   Rarely
Please make a selection.

36. Do you tell people that you have been waiting for them for a long time?

Always   Sometimes   Occasionally   Rarely   Please make a selection.

37. Do you listen to others' opinions and consider them as possibly correct?

Always   Sometimes   Occasionally   Rarely   Please make a selection.

38. Do you find yourself interrupting others?

Always   Sometimes   Occasionally   Rarely   Please make a selection.

39. Do you take on whatever task given to you without complaint?

Always   Sometimes   Occasionally   Rarely
Please make a selection.

40. Would others think of you as shy?

Always   Sometimes   Occasionally   Rarely
Please make a selection.

41. Do you like to be the leader in a group project?

Always   Sometimes   Occasionally   Rarely
Please make a selection.

42. Are you frustrated if someone else has power over you?

Always   Sometimes   Occasionally   Rarely
Please make a selection.

43. Do you accept responsibility for your errors?

Always   Sometimes   Occasionally   Rarely
Please make a selection.

44. Do you drop out of projects, programs, or groups?

Always   Sometimes   Occasionally   Rarely   Please make a selection.

45. Do you have a short attention span?

Always   Sometimes   Occasionally   Rarely   Please make a selection.

---

46. Please explain, in 200 words or less, why you should be chosen to participate in the Biggest Loser Program.

A value is required.

47. Are you currently a member of the RAC? No Yes

Thank you for your interest in GSU Biggest Loser. The application period for Spring 2012 has closed. We invite you to apply for Fall 2012 starting June 1. Thank you!