NAME: ______________________, BLOCK: ________________

Please fill out at the end of class.

WEEK ONE CHECKLIST
September 19 - 25

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
_____________________________________________________________________________________________
WEEK TWO CHECKLIST
September 26 October
2

Sat

Sun

Mon

Tues

Wed

Thurs

Fri

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
_____________________________________________________________________________________________
WEEK THREE CHECKLIST
October 3 9

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
WEEK FOUR CHECKLIST

October 10 16

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
_____________________________________________________________________________________________

WEEK FIVE CHECKLIST

October 17 - 23

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
_____________________________________________________________________________________________

WEEK SIX CHECKLIST

October 24 - 30

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

1st Diaphragmatic breath

work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________

WEEK SEVEN CHECKLIST

October 31 November

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

6
1st Diaphragmatic breath
work

2nd Diaphragmatic
breath work

__________ Xs (number of times your practiced breath work this week)

Write down anything significant that happened to you this week (good/bad):
____________________________________________________________________________________________
_____________________________________________________________________________________________

PLEASE FILL IN WHEN APPROPRIATE!

Pre-Test Score: __________________

Post-Test Score: _________________
DIFFERENCE: ____________________
Average time per week you did breath work (do the average for the 7 weeks
please): ______________________

Did you enjoy this experiement? Why or why not?

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Will you continue with breath work? Why or why not?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
How has breath work helped you?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

PLEASE FILL THIS IN ACCURATELY:

FULL NAME: _______________________________________, BLOCK:
_________
I am in a control group ____ yes, ____ no.
Pre-test score:

___________________________

Post-test score:

__________________________

_________________________________________________________

Difference of the two scores: ("+" if score went up, or "- " if score went down)
_________________________________

AVERAGE of the # of times I did breath work per week

(add up all the times you did breath work and divide by 5
to get your answer). _________

Did anything significant happen during the three weeks of doing this project
(serious illness, death of a loved one or pet, moved houses etc.)
______________________________________________________
_____________________________________________________________________________________

Was this an easy project for you to be a part of? ____________________

What could make this project even better?

_________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

THANK-YOU!!!!!