Program Participation

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Overview

Data Form
Response Options

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Sheet 1: Data Form

Participant ID

Date data collected

Data collection interval

Date first participated in programming

Physical Activity 60-min

Time Active yesterday

PLAY Inventory

PLAYbasic-Run there and back

PLAYbasic-Hop

PLAYbasic-Overhand throw

PLAYbasic-Kick ball

PLAYbasic-Balance walk backward

Fruit

Vegetable

Pop

Sports drink

Proportion of low-income/FRL participants at youth’s school

Sex

Ethnicity

Race1

Race2

Race3

Race4

Please ensure the participant maintains the same ID throughout the study

##/##/####

(Baseline, 3-month, 6-month)

##/##/#### or Not Started

(No, Yes, Not sure )

(Less than 15 min; 15 min to 29 min; 30 min to 44 min; 45 minto 59 min; 60 min or more; Not sure

Score=number of sports checked

Score=1-100

Score=1-100

Score=1-100

Score=1-100

Score=1-100

(No, Yes, Not sure )

(No, Yes, Not sure )

(No, Yes, Not sure )

(No, Yes, Not sure )

Please enter a decimal number <=1.

(Male; Female)

(Hispanic; Not-Hispanic)

(White ; Black/African American ; American Indian or Alaska Native; Asian ; Native Hawaiian/Pacific Islander)

(White ; Black/African American ; American Indian or Alaska Native; Asian ; Native Hawaiian/Pacific Islander)

(White ; Black/African American ; American Indian or Alaska Native; Asian ; Native Hawaiian/Pacific Islander)

(White ; Black/African American ; American Indian or Alaska Native; Asian ; Native Hawaiian/Pacific Islander)

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Sheet 2: Response Options

Participant ID	Date	Data collection interval	Physical Activity 60-min	Time Active yesterday	Play Inventory	PLAYbasic scores	Fruit	Vegetable	Pop	Sports drink	Proportion of low-income/FRL participants at youth’s school	Sex	Ethnicity	Race1	Race2	Race3	Race4
		(Baseline, 3-month, 6-month)	(No=0, Yes=1, Not sure = 2)	(1= Less than 15 minutes; 2= 15 minutes to 29 minutes; 3=30 minutes to 44 minutes; 4=45 minutes to 59 minutes; 5=60 minutes or more; 6=Not sure	score=count number of sports		(No=0, Yes=1, Not sure = 2)	(No=0, Yes=1, Not sure = 2)	(No=0, Yes=1, Not sure = 2)	(No=0, Yes=1, Not sure = 2)		(1=Male; 2=Female)	(Hispanic=1; Not-Hispanic = 0)	(White = 1; Black/African American = 2; American Indian or Alaska Native = 3; Asian = 4; Native Hawaiian/Pacific Islander = 5)
		Baseline	No	Less than 15 minutes		1	No	No	No	No		Male	Hispanic	White	White	White	White
		3-month	Yes	15 minutes to 29 minutes		2	Yes	Yes	Yes	Yes		Female	Not-Hispanic	Black/African American	Black/African American	Black/African American	Black/African American
		6-month	Not sure	30 minutes to 44 minutes		3	Not sure	Not sure	Not sure	Not sure				American Indian or Alaska Native	American Indian or Alaska Native	American Indian or Alaska Native	American Indian or Alaska Native
				45 minutes to 59 minutes		4								Asian	Asian	Asian	Asian
				60 minutes or more		5								Native Hawaiian/Pacific Islander	Native Hawaiian/Pacific Islander	Native Hawaiian/Pacific Islander	Native Hawaiian/Pacific Islander
				Not sure		6
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