TIMU Baseline Survey

OMB control #:

Expiration date:

Survey I.D. # _______

Timucuan Explorer Evaluation Survey: PRE-TEST (Day-1)

This survey seeks to learn your feelings and thoughts about the Timucuan Explorer Kayaking Program. It will take 5 minutes to complete the survey. Feel free to ask questions. Your responses are voluntary and will remain anonymous.

1. Do you know how to swim?

• No

• Yes

2. Do you like to swim?

• No

• Yes

3. Have you paddled a kayak before?

• No

• Yes

4. The idea of paddling a kayak is ______ for me (check one):

• Exciting

• Boring

5. The idea of paddling a kayaking is ______ for me (check one):

• Not scary

• Scary

6. How many days do you usually exercise in a 7-day week (for example: football, basketball, baseball/softball, swimming, bicycling, skating, jumping rope)?

0 days 1-2 days 3-4 days 5-7 days

7. If you exercise one or more days a week, write the types of activities you do:________________________________________________________________________

PRIVACY ACT and PAPERWORK REDUCTION ACT statement:

16 U.S.C. 1a-7 authorizes collection of this information. This information will be used by park managers to better serve the public. Response to this request is voluntary. No action may be taken against you for refusing to supply the information requested. Your name is requested for follow-up mailing purposes only. When analysis of the questionnaire is completed, all name and address files will be destroyed. Thus the permanent data will be anonymous. Please do not put your name or that of any member of your group on the questionnaire. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Person collecting and analyzing information: John Eisler, Ph.D., Dept. of Psychology, University of North Florida, Jacksonville, Florida 32224-2673, phone (904) 620-1633..

Burden estimate statement: Public reporting burden for this form is estimated to average 5 minutes per response. Direct comments regarding the burden estimate or any other aspect of this form to: Daniel Tardona, Timucuan Ecological and Historic Preserve, 12713 Fort Caroline Road, Jacksonville, Florida 32225, phone (904) 221-7567.

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