Name: ____________________

1. Name: ____________________ Self Assessment The following brief test will help you to analyze your well-being in each of the three areas of wellness. For each question, choose the answer that best describes your behavior; then add up your score for each section. Almost always Sometimes Never • Exercise/Fitness • I engage in moderate exercise, such as brisk walking or swimming, for 20-60 minutes, three to five times a week. • I do exercises to develop flexibility at least twice a week. • I spend some of my leisure time participating in individual, team, or family activities. • I maintain a healthy body weight, avoiding underweight and overweight. 4 1 0 2 1 0 2 1 0 2 1 0 Exercise/ Fitness Score: • Nutrition • I eat a variety of foods each day, including five or more servings of fruits/vegetables. • I limit the amount of fat and saturated fat in my diet. • I avoid skipping meals. • I limit the amount of salt and sugar I eat. 3 1 0 3 1 0 2 1 0 2 1 0 Nutrition Score: • Emotional Health • I enjoy being a student, and I have an after school activity I enjoy. • I find it easy to relax and express my feelings freely. • I manage stress well. • I can use criticism to make improvements. • I have confidence in the things I do. 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 Emotional Health Score:

2. Almost always Sometimes Never • Social Health • I have close friends, relatives, or others whom I can talk to about personal matters and call on for help when needed. • I can share ideas with others and get along even if we disagree. • I participate in group activities that I enjoy. • I show respect to others and stand up for people that are being harassed or bullied. 4 1 0 2 1 0 2 1 0 2 1 0 Social Health Score: What Your Score Means Scores of 9 and 10 Excellent! Your answers show that you are aware of the importance of this area of your overall well-being. More importantly, you are putting your knowledge to work for your health by practicing good habits. As long as you continue to do so, this area should not pose a serious health risk. Because you got a high score on this part of the test, you may want to consider other areas where your scores indicate room for improvement. Scores of 6 to 8 You health practices in this area are good, but there is room for improvement. Look again at the items you answered with a “Sometimes” or “Never”. What changes can you make to improve your score? Even a small change can often help you achieve overall well-being. Scores of 3 to 5 Your health risks are showing! Would you like more information about the risks you’re facing and about why it’s important for you to change these behaviors? Perhaps you need help deciding how to successfully make the changes you desire. In either case, wellness class will help! Scores of 0 to 2 Obviously, you were concerned enough about your overall well-being to take this test, but your answers show that may be taking serious and unnecessary risks with your health. Perhaps you are not aware of the risks and what to do about them. You can easily get the information and help you need from this course!

3. Physical Health • Stiff • Energetic • Bulky • Healthy • Restricted • Unsafe • Unattractive • Unhealthy Put an X next to ALL words or phrases that describe how you feel about your physical self • Flexible • Easily tired • Tolerant of pain • Powerful • Sick • Free • Attractive • Weak • Safe • Thin • Poorly defined • Not muscular • Awkward • Fast • Uncoordinated • Unfit • Strong • Heavy • Well-defined • Muscular • Graceful • Slow • Coordinated • Fit Decide whether the statement is true or false when describing you T / F I am not sick very often T / F I feel great physically T / F I exercise for 30 minutes at least 4 times a week T/ F/ I eat 2 servings of fruit AND 2½ cups of vegetables a day T / F I only drink 1 can of soda a week T / F I participate in PE every class WITH EFFORT T / F I only eat at a fast food restaurant one time a month T / F I don’t watch TV for more than 30 minutes a day T / F I get at least 8 hours of sleep on school nights T / F I eat whole wheat bread instead of white bread T / F I drink skim milk T / F I only eat one sugary snack or dessert a day In one sentence, summarize your physical health: ________________________________________________________________________________ ________________________________________________________________________________

4. Emotional Health • Blame others • Sulk • Sleep • Exercise • Eat • Hit someone • Hit something • Talk to a friend Put an X next to ALL words or phrases that describe how you feel emotionally most days Put an X next to words or phrases that describe how you react to difficult tasks or stressful situations • Insecure • Stressed • Carefree • Powerful • Worried • Relaxed • Insecure • Uptight • Scream • Cry • Breath • Procrastinate • Ask for help • Refuse • Get started • Become impatient • Happy • Pessimistic • Nervous • Timid • Optimistic • Unhappy • Sad • Angry Decide whether the statement is true or false when describing you T/ F/ When someone close to me is sick or hurt I am sad T / F I like the way I look T / F When I am stressed out I have a healthy stress relief method T / F I can handle criticism from teachers without getting down T / F When I am in a group of friends I go with the crowd, even when I disagree T / F I have contemplated using a weight loss aid T / F I don’t join clubs or activities because I do not want to fail T / F I can apologize easily when I make mistakes T / F I am confident in what I do T / F I feel upbeat and positive most of the time T / F I volunteer in class even when I am not sure of the answer In one sentence, summarize your emotional health: ________________________________________________________________________________ ________________________________________________________________________________

5. Social Health Put an X next to ALL words or phrases that describe how you interact with others • Demanding • Unpopular • A bully • Timid • Unfriendly • Quiet • Outgoing • A victim of bullying • Enjoys being alone • Works well with others • Uninterested in others • Uncooperative • Unreliable • Trustworthy • Has close friends • Lonely • Shy • Easy talker • Interested in others • Friendly • Popular • Cooperative • Mean • Forceful Decide whether the statement is true or false when describing you T / F I have one or more close friends I can confide in T / F I am a good friend to others T / F I have different groups of friends (team, class, neighbors) T/ F/ I talk about people behind their backs T / F I pick on the unpopular kids in school T / F I get bullied and don’t tell anybody T / F I I fight with my parents at least 4 times a week T / F I hate someone T / F I can not work in a group with someone if I don’t like him or her T / F I eat at different lunch tables to talk to different people T / F I can not make it through the day if my best friend is not at school T / F I listen when others talk In one sentence, summarize your social health: ________________________________________________________________________________ ________________________________________________________________________________