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Nutrition Survey
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* Indicates required question
How many servings of fruits do you typically eat at breakfast?
*
0
1
2
3
How many servings of whole grians do you typically eat at breakfast?
*
0
1
2
3
How many servings of milk do you typically eat/drink at breakfast?
*
0
1
2
3
How many servings of vegetables do you typically eat at breakfast?
*
0
1
2
3
How many servings of fruits do you typically eat at lunch?
*
0
1
2
3
How many servings of whole grains do you eat at lunch?
*
0
1
2
3
How many servings of milk do you eat/drink at lunch?
*
0
1
2
3
How many servings of vegetables do you eat at lunch?
*
0
1
2
3
How many servings of fruits do you typically eat dinner?
*
0
1
2
3
How many servings of whole grains do you typically eat at dinner?
*
0
1
2
3
How many servings of milk do you eat/drink at dinner?
*
0
1
2
3
How many servings of vegetables do you generally eat at dinner?
*
0
1
2
3
Please check any of the following extracurricular physical activities that you participate in.
*
Morning Monkeys
Football
Baseball/Softball
Soccer
Basketball
Dance
Karate
Other
Required
Grade
*
Choose
K
1st
2nd
3rd
4th
5th
6th
8th
High School Student
Age 18 +
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