Student Health Assessment Questionnaire

Today, you will be asked to complete a survey that assesses what young people typically eat and what they do for physical activity. The results of the survey will help schools design better health programs, offer food choices that students like, and provide fun physical activities. The survey should take about 15 minutes to complete.

This survey is not a test, and there are no right and wrong answers. Your teacher will not see your answers and they will not be sent home for your parents to review. We ask that you answer the questions as honestly as possible and select the one answer that is most true for you.

Some of the questions on the survey will ask you how many times you ate or drank a certain type of food or drink yesterday. If you cannot remember the exact number of times you ate or drank this item, you can simply use your best estimate. In addition, you do not need to report the number of the particular items you ate or drank (for example, 8 strawberries or 2 pieces of watermelon). Instead, you are asked to report how many times during the day you ate these items. In addition, a number of the survey items will ask you to think about the number of times you did something in a typical week. Please consider “a week” to be a full seven days, not just the five-day school week.