DIY Health Project Plan (from scratch)

Recommended: an advisor and project participant(s) working through this together. Those without an advisor or coach may prefer to follow a template from a book or website. There is a space for comments or questions in the last section.

When you hit SEND, your information gets emailed to us. In a week or less we'll convert it and invite you to view and edit a customized online Google Sheets log. Time to connect!
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SECTION 1: About You

Your email:

Your age in years:

Your gender:
FemaleMaleTransOther

Your home state:
Select oneMaine (ME)New Hampshire (NH)Massachusetts (MA)Other (specify below)
Other state or country:

Your school (if applicable):

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SECTION 2: Project Overview

What health topic does the project primarily cover?
Select oneBreathingChemical dependencyDental healthEmotional healthFood - eatingFood - obtainingFood - preparingHydrationHygieneMeditationPhysical activity/exercisePhysical safetyPostureScreen timeSleepSocial mediaOther (describe below)

Describe the specific project in a sentence or phrase (feel free to copy and paste from this list of possibilities):

What is the primary project goal?

When will the project start?

How long are you planning to have the project last? (Note: 1 to 2 months works well for many experiments)
Select one1 week2 weeks1 month2 months3-6 months6-12 monthsOver a yearOther (describe below)

On which day do you prefer your log weeks to start?
SundayMonday

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SECTION 3: Support and Communications Plan

Safety note: check with a health professional before and during projects if possible, especially if you feel sick or unsafe at any point.

Will you communicate with any groups, professionals, teachers, or mentors about the experiment?
Select oneYesNo

If an INDIVIDUAL is involved, their name (optional):

The individual's position or role:
Select oneTeacherCoachSchool nurseMentorDoctorPhysician's assistantNurse practitionerParentFriendOther individual (describe below)

How will you communicate with this person before, during, and after the experiment?
Select oneEmailText or FB messagePhone callFace-to-faceOther (describe below)

How frequently will you communicate with them?
Select oneDailyWeeklyEvery other weekMonthlyOther (describe below)

If a GROUP is involved, its name:

Type of group:
Select oneNon-profit organizationTeamSchool clubOther (describe below)

How will you communicate with this group before, during, and after the project?
Select oneEmailText or FB messagePhone callFace-to-faceOther (describe below)

How frequently will you communicate with them?
Select oneDailyWeeklyEvery other weekMonthlyOther (describe below)

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SECTION 4: Completion Plan

What are the primary actions involved in completing the project?

If you don't have a coach, would you like action suggestions from us?
No - all setYes

1.

2.

3.

4.

5.

POTENTIAL CHALLENGES

If something (or things) might make completing the actions above challenging, please describe along with a strategy for getting them done regardless.

Would you like examples of challenges and strategies others have noted in similar projects?
No - I'm all setYes

1.
    Strategy:

2.
    Strategy:

3.
    Strategy:

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SECTION 5: Logging Plan

List any actions or health indicators you'd like to log and how often (daily, weekly, or other). Recommended: focusing on one or two actions to start and using up to 8 health indicators to measure or assess.

Action examples:

• Daily workout time

• Servings of vegetables or sugary beverages

• Hours slept

• Number of stretch breaks

Health indicator examples:

• Energy level

• Focus ability

• Sleep quality

• Workout quality

Would you like any more action or health indicator suggestions from us?
No - all setYes

1.
    Select oneWeeklyDailyOther (include above)

2.
    Select oneWeeklyDailyOther (include above)

3.
    Select oneWeeklyDailyOther (include above)

4.
    Select oneWeeklyDailyOther (include above)

5.
    Select oneWeeklyDailyOther (include above)

6.
    Select oneWeeklyDailyOther (include above)

7.
    Select oneWeeklyDailyOther (include above)

8.
    Select oneWeeklyDailyOther (include above)

9.
    Select oneWeeklyDailyOther (include above)

10.
    Select oneWeeklyDailyOther (include above)
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SECTION 6: Reporting and Presenting

Will you report the results to anybody? Check those that apply
Teacher(s)Mentor(s)Coach(es)Classmate(s)Friend(s)Other (describe below)

Will you receive academic credit for this project?
YesNo

Are you presenting the results in one or more of these ways?
Completed formPresentationPaperPosterOther (describe below)

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SECTION 7: Follow-Up Plan

What might your project follow-up include?
Using lessons learned to continue, expand, replace, or change it
Taking steps to involve others in similar projects
Other (describe below)

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SECTION 8: Feedback or Questions

Do you have any questions about this process that 3Levels.org might be able to help you with?

Do you have comments about this form or ideas for making it more user-friendly?