Questionnaire

 

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II. Instructions:

Please CIRCLE ONE of the two foods that you think is better for your health:

1. a. whole wheat bread b. white bread
2. a. broiled beef b. broiled fish
3. a. cereal b. eggs and bacon
4. a. beef b. beans
5. a. green salad b. French fries
6. a. 100% fruit juice b. fruit punch

Analysis of the Question:

 III. Instructions:

    The questions in this section ask how likely you are to be physically active or eat certain foods.  Please answer by circling either NOT LIKELY, LIKELY or VERY LIKELY for each question.

1. How likely are you to be physically active 3-5 times a week?
    a. Not likely        b. Likely         c. Very likely

2. How likely you to exercise and keep moving for most of the time in your after school program?
    a. Not likely        b. Likely         c. Very likely

3. How likely are you to run or CYCLING 3-5 times a week?
    a. Not likely        b. Likely         c. Very likely

4. How likely are you to keep up a steady pace without stopping for 15-20 minutes when you are physically active?
    a. Not likely        b. Likely         c. Very likely


Analysis of the Questions:

Questionnaire to Parents: