School Wellness Assessment Form
Please complete the School Wellness Assessment Form to help us understand and improve wellness at your school.
Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
How often do you participate in physical activity at school?
*
Every day
Most days
Some days
Rarely
Never
How would you rate the quality of meals provided at your school?
*
1
2
3
4
5
How safe do you feel at school?
*
Not safe
1
2
3
4
Very safe
5
1 is Not safe, 5 is Very safe
How supported do you feel by your teachers and school staff?
*
Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
How often do you eat fruits and vegetables at school?
*
Every day
Most days
Some days
Rarely
Never
How easy is it to access water throughout the school day?
*
Very easy
Somewhat easy
Neutral
Somewhat difficult
Very difficult
Please indicate how much you agree with the following statements about your school:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel welcome at school
1
2
3
4
5
There are opportunities for physical activity
6
7
8
9
10
Healthy food options are available
11
12
13
14
15
I have someone to talk to if I need help
16
17
18
19
20
What do you think could be improved to support wellness at your school?
Overall, how would you rate your school's approach to wellness?
*
1
2
3
4
5
Submit Assessment
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