Small Steps to Health and Wealth™ Online Registration

Welcome to the Small Steps to Health and Wealth™ online registration page. Here you will set your health and/or wealth goal. Researchers at Rutgers University and the University of Arizona will contact you periodically by e-mail to motivate you and check on your progress. The registration takes about 5 minutes to complete.

Your individual progress reports (e.g., weight lost, dollars saved) will be added to those of other Small Steps to Health and Wealth™ program participants. Personal data will be kept completely confidential and no individual behavior changes will be made public.

Participation in the online registration system of the Small Steps to Health and Wealth™ Web site is completely voluntary (see also Legal Disclaimer). By participating, however, you will increase accountability for your progress and help researchers study links between health and personal finances. If you choose to participate, please take a minute to complete the Small Steps to Health and Wealth™ registration form, below.

Personal Information:

First Name:

Last Name:

State of Residence:

County of Residence:

E-mail Address:

E-mail Address (confirm):

Height in Feet and Inches (e.g., 5’6”)

Weight (e.g., 162 pounds)

Gender:
Male
Female

Ethnic Background:
White (Non-Hispanic)
African-American
Hispanic/Latino
Asian/Pacific Islander
Other (specify)

Year of Birth:

Marital Status:
Single (Never Married)
Married or living as married
Widowed and not remarried
Separated
Divorced and not remarried

Highest Educational Level:
Did not complete high school
Completed high school or equivalent
Completed technical/vocational school
Some college or Associate’s degree
Attained a Bachelor’s degree
Attained a graduate degree

Employment Status:
Retired, not working for pay
Full time homemaker (not working outside home)
Work less than 20 hours a week
Work more than 20 hours a week
Currently seeking employment
Currently a full time student

Household Income (Before Taxes) from All Sources:
$20,000 or below
$20,001 to $40,000
$40,001 to $60,000
$60,001 to $80,000
$80,001 to $100,000
over $100,000

How would you rate your overall physical health at the present time?
Excellent
Good
Fair
Poor

How would you rate your overall personal finances at the present time?
Excellent
Good
Fair
Poor


 

Partner Logos