We thank you for your interest in the program and are looking forward to getting started with you!
Please note that the information provided will remain confidential and will only be accessed by the MoveU.HappyU program coordinators. Should you feel uncomfortable answering any of the following questions, you may leave them unanswered. Once the form is submitted, a program coordinator will be in contact with you to provide further information about your involvement in the program.
Full Name (First and Last):
Email
* must provide value
Are you an international student?
* must provide value
Yes
No
Male
Female
Genderfluid
Non-binary
Genderqueer
Transgender
Two-spirit
Prefer not to say
Other
Male
Female
Genderfluid
Non-binary
Genderqueer
Transgender
Two-spirit
Prefer not to say
Other
If other, please specify:
Are you currently an undergraduate or graduate student?
Undergraduate
Graduate
Other
Undergraduate
Graduate
Other
If other, please specify:
We have male and female coaches, would you prefer to meet with a:
Male coach
Female coach
No preference
Male coach
Female coach
No preference
How did you hear about MoveU.HappyU?
Health and Wellness Counselor
Friend/Peer
Embedded Faculty Counselor
MoveU.HappyU Advertisement
Centre for International Experience
Other
Health and Wellness Counselor
Friend/Peer
Embedded Faculty Counselor
MoveU.HappyU Advertisement
Centre for International Experience
Other
If other, please specify:
Strenuous Exercise (Heart Beats Rapidly):
(e.g., running, jogging, hockey, football, soccer, squash, basketball, cross country skiing, judo, roller skating, vigorous swimming, vigorous long distance bicycling) [TIMES PER WEEK]
Moderate Exercise (Not Exhausting):
(e.g., fast walking, baseball, tennis, easy bicycling, volleyball, badminton, easy swimming, alpine skiing, popular ad folk dancing) [TIMES PER WEEK]
Mild/Light Exercise (Minimal Effort):
(e.g., yoga, archery, fishing from the river bank, bowling, horseshoes, golf, snowmobiling, easy walking) [TIMES PER WEEK]
In general, how would you say your mental health is:
Poor
Fair
Good
Very good
Excellent
Poor
Fair
Good
Very good
Excellent
In general, how would you rate your overall health?
Poor
Fair
Good
Very good
Excellent
Poor
Fair
Good
Very good
Excellent
Have you had an injury in the last year that has prevented you from exercising
Yes
No
Has your Doctor suggested in the last year that you should not partake in physical activity or exercise
Yes
No
Where are you physically located right now (e.g., on campus, somewhere in Canada, international)?
Please indicate the time zone you are currently located in.