6th - 8th GRADE NUTRITION EDUCATION SURVEY


STUDENT’S CODE NUMBER__________________  DATE____________   ___PRE	 ___POST

DO NOT write your name on this survey.
The answers you give will be kept private. This survey is voluntary.

For each question, circle the answer that best describes you.

The first 4 questions ask about food you ate or drank.


1. Yesterday, how many times did you eat vegetables, not counting French fries?  Include cooked vegetables, canned vegetables and salads.  If you ate 2    different vegetables in a meal or snack, count them as 2 times.

   0 - None
   1 - 1 time
   2 - 2 times
   3 - 3 times
   4 - 4+ times


2. Yesterday, how many times did you eat fruit, not counting juice? Include fresh, frozen, canned, and dried fruits.  If you ate 2 different fruits in a    meal or snack, count them as 2 times.

   0 - None
   1 - 1 time
   2 - 2 times
   3 - 3 times
   4 - 4+ times


3. Yesterday, how many times did you drink non-fat or 1% low fat milk?  Include low fat chocolate or flavored milk, and low fat milk on cereal.

   0 - None
   1 - 1 time
   2 - 2 times
   3 - 3 times
   4 - 4+ times


4. Yesterday, how many times did you drink sweetened drinks like soda, fruit-flavored drinks, sports drinks, energy drinks and vitamin water? Do not include    100% fruit juice.

   0 - None
   1 - 1 time
   2 - 2 times
   3 - 3+ times


The next 2 questions ask about how often you choose certain foods. 

5. When you eat grain products, how often do you eat whole grains, like brown rice instead of white rice, whole grain bread instead of white bread, and    whole grain cereals?
  
   1 - Never
   2 - Once in a while
   3 - Sometimes
   4 - Most of the time
   5 - Always


6. When you eat out at a restaurant or fast food place, how often do you make healthy choices when deciding what to eat?

   1 - Never
   2 - Once in a while
   3 - Sometimes
   4 - Most of the time
   5 - Always


The next 3 questions are about physical activity. 


7. During the past 7 days, how many days were you physically active for at least 1 hour?

   0 - 0 days
   1 - 1 day
   2 - 2 days
   3 - 3 days
   4 - 4 days
   5 - 5 days
   6 - 6 days
   7 - 7 days

	
8. During the past 7 days, how often were you so active that your heart beat fast and you breathed hard most of the time?

   1 - Never
   2 - 1 time last week
   3 - 2 times last week
   4 - 3 times last week
   5 - 4 or more times last week


9. How many hours a day do you spend watching TV or movies, playing electronic games, or using a computer for something that is not school work?

   1 - 1 hour or less
   2 - 2 hours
   3 - 3 hours
   4 - 4 hours
   5 - 5 or more hours

The next 3 questions are about how you handle food.

	
10. How often do you wash your hands before eating?  Think about eating at school or at home.

    1 - Never
    2 - Once in a while
    3 - Sometimes
    4 - Most of the time
    5 - Always


11. How often do you wash vegetables and fruits before eating them?

    1 - Never
    2 - Once in a while
    3 - Sometimes
    4 - Most of the time
    5 - Always


12. When you take foods out of the refrigerator, how often do you put them back within 2 hours?

    1 - Never
    2 - Once in a while
    3 - Sometimes
    4 - Most of the time
    5 - Always


The next 2 questions ask about your confidence in food preparation. 

	
13. How confident are you in using measuring cups and measuring spoons?

    1 - Not confident
    2 - Somewhat confident 
    3 - Confident
    4 - Totally confident


14. How confident are you in following directions in a recipe?

    1 - Not confident
    2 - Somewhat confident 
    3 - Confident
    4 - Totally confident


Developed by the EFNEP Youth Evaluation Committee	                    Rev. 9/23/2014                                                 www.efnep.org


YOUTH EVALUATION                                                                                                        FISCAL YEAR 2015   Rev. 9/2/2014