Health and Happiness Inventory

Thank you for electing to participate in this health and happiness inventory. The following questions seek to understand the link between actual and perceived health and perceived happiness. The questionnaire should take no more than 15-20 minutes to complete. The data being collected for this study is for informational purposes only, and no identifying information will be attached to your survey results. Below is a list of the qualifying information for this survey:

Must be between the ages of 8 and 13 as of August 1, 2012.

Must be in basic good health, with no chronic or long-term illnesses/diseases (ie. cancer, diabetes, etc.)

Must not be currently under the care or counsel of a psychiatrist, psychologist or counselor or being treated for any type of psychotic problems.

Must know approximate height and weight

Must have parent/guardian permission to complete survey: any parent/guardian questions, comments and concerns should be directed to Victoria Feger: vfeger08 , 6263216356

Parent Permission – Please fill out all highlighted portions to be included in this survey:

I, (Tracie Zerpoli), do acknowledge and allow my child, (Emily Zerpoli), aged (13) years, to complete the following questionnaire for the purpose of an undergraduate psychology school project, to be turned in by Victoria Feger, on August 22, 2012 to Professor Drew Carr, of Azusa Pacific University. I understand that the results of this questionnaire will not be made public, and will not be published in any way, shape or form without written notice to the contact information I provide. I also acknowledge that I will receive no notification of the answer my child provides, and that it is up to their discretion to share the information with me, unless I am contacted about publishing.

Parent Name: Tracie Zerpoli

Email Address: tzerpoli

Additional Contact info (if contact other than email is desired):

Date: 8/20/12

Questionnaire – Please enter a numerical value when asked. For multiple-choice questions, please choose the most correct answer by bolding or highlighting your response:

Q1: What is your weight? (Please enter a whole numeric value, rounded to the nearest one. For example, if your weight is 192.2 pounds, please enter 192. If your weight is 192.9 pounds, please enter 193. Always round up on a .5.)

A1: 120 pounds

Q2: What is your height? (Please enter a whole numeric value, rounded to the nearest one. For example, if your height is 61.1 inches, please enter 61. If your weight is 61.8 inches, please enter 62. Always round up on a .5.)

A2: 65inches

Q3: Do you feel that your weight has an impact on your happiness level?

A3: Yes No

Q4: What is your current happiness level (right now)?

Please use a one-to-ten scale, where a 1 signifies extreme unhappiness, a 5 signifies neither happy nor sad, and a 10 signifies extreme happiness.

A4: 6 7 8 9 10

Q5: During a typical week (with a week starting on Sunday and ending the following Saturday) what is your average typical happiness level?

Please use a one-to-ten scale, where a 1 signifies extreme unhappiness, a 5 signifies neither happy nor sad, and a 10 signifies extreme happiness.

A5: 6 7 8 9 10

Q6: Compared to most of your close friends, are you generally more happy, less happy, or the same happy as they are on a typical day?

A6: More Happy The Same Amount of Happy Less Happy

Q7: Compared to most of your close friends, are you thinner, about the same, or heavier in weight?

A7: Thinner About the Same Heavier

Q8: Compared to other people your age (at school, church, sports, etc) are you generally more happy, less happy, or the same happy as they are on a typical day?

A8: More Happy The Same Amount of Happy Less Happy

Q9: Compared to other people your age (at school, church, sports, etc), are you thinner, about the same, or heavier in weight?

A9: Thinner About the SameHeavier

Q10: Do you personally believe that there is a relationship (positive or negative) between your weight and your happiness?

A10: Yes No

Please submit all completed surveys to Victoria Feger no later than 8pm, Saturday, August 25, 2012 via email to vfeger08 .

Thank you for your participation!