Active Influencers Core Questions
Participant REF 0
Participant Forename*
Participant Surname*
Mentor
Date Completed
The participant is exiting programme?
  

INFLUENCERS QUESTIONS

This will be a web diagram which is revisited at months 1, 3,6,9 and programme end

    
I WANT to be more Physically Active*
    
I AM ABLE TO BE MORE PHYSICALLY ACTIVE*
    
I SEE PEOPLE LIKE ME BEING PHYSICALLY ACTIVE*
    
THE PEOPLE AROUND ME MAKE IT EASIER TO BE PHYSICALLY ACTIVE*
    
I AM SURROUNDED BY THINGS THAT MAKE IT EASY TO BE PHYSICALLY ACTIVE*
    
I am surrounded by THINGS that make me WANT to be physically active*
Conversation notes Mentor:

Active, Energised & Confident

Moving Forward Together is a programme that aims to help people become more active and move them closer to employment and the job market.

How Ready do you feel to be Active on a scale of 0-10

0 = Not Ready to get active    5 = Somewhat Ready    10 = Ready to be active


How Ready do you feel to Work, on a scale of 0-10

0 = Not Ready to get active    5 = Somewhat Ready    10 = Ready to be active