Bahavioral Outcomes

Dear Student,

Please take a few minutes to answer this short survey. If you need help reading a question, please raise your hand. Your teacher or a helper will be able to read it for you. Remember to answer each question the best you can. Thanks!

Linda Scheuermann
Nutrition Educator

1. When do you like to eat fruits or vegetables? Check all the times you eat fruits or vegetables.

2. How often do you buy a school lunch?

Always

Sometimes

Never

3. When you buy a school lunch, do you eat the fruits and vegetables on your tray?

I usually eat both the fruit and vegetable.

I usually only eat the fruit.

I usually only eat the vegetable.

I do not eat fruits and vegetables.

4. If you bring a lunch from home, who makes your lunch?

My mom (step-mom) or dad (step-dad) makes my lunch.

My sister or brother makes my lunch.

Someone else at home makes my lunch.

I make my own lunch.

No one. I buy a school lunch everyday.

5. Select the fruits and vegetables you like to eat.

6. I bring a water bottle to school.

Always

Sometimes

Never

7. I eat breakfast before school.

Always

Sometimes

Never

8. How often do you eat dinner with your family at home during the week?

Always

Sometimes

Never

9. Which Youth Services after school sports or physical activities are you signed up for now?

10. How often do you eat at the on-post fast food court?

at least once per week

at least once per month

sometimes

never