1. Have you ever had Girl Scout Cookies? Yes No
2. Which type is your favorite? (circle one)

Samoas - Worlds Most Delicious Cookie

Thin Mints - Made with Natural Peppermint

Do-si-dos - Peanut Butter Sandwich Cremes

Tagalongs - Peanut Butter Patties

All Abouts - Shortbread Cookie/ Rich Fudge Bottom

Ole' Ole' - Bite-sized Vanilla, Pecan Chips, Coconut Coated in Powdered Sugar (low fat)

Trefoils - Old Fashioned Tender Shortbread

Aloha Chip - With Macadamia Nuts

3. Do you wish Girl Scout cookies could be sold all year? Yes No
4. Who do you usually buy cookies from? Friend Relative Stranger
5. Age: 10 & under 11-13 14-18 19 or older

1. Do you eat the lunch served in the lunchroom at least 1 day a week? Yes No
2. What is your favorite food served?

• Pizza
• Chicken Fingers
• Burritos
• Hot Pockets
• Chicken Sandwich
• Spaghetti
• Meatloaf
• Fried/Baked Chicken
• Pork Chops
• Country Fried Steak
• Soups/Cheese Sandwich
• Salad Bar
• Other___________________

1. How many days a week do you eat the Pizitz Lunch?
2. How many days a week do you bring your lunch?
3. What beverage do you usually choose?

Milk Chocolate Milk Tea Water Other

4. What grade are you in? 6th 7th 8th

1. What types of garbage did you find when you cleaned up? Circle all that apply.

• Cigarette butts: Marlboro, Camel, Other
• Soda cans/bottles: Coke, Pepsi, Other
• Fast food wrappers/containers/etc.: McDonald's, Burger King, Taco Bell, Wendy's, KFC, Other
• Newspapers
• Magazines
• Mail
• Other

1. Where did you find large concentrations of garbage?

 

 

2. What other types of trash did you find

1. What grade are you in? 6th 7th 8th

 

2. What is your Favorite Subject?

• Math
• English
• Social Studies
  Science
• Computer
• Reading
• PE
• Choral
• Band
• Art
• Foreign Language
• Speech/Drama
• Tech Lab
• Other

1. Do you learn better in the morning or afternoon? Morning Afternoon

 

2. Do you like the rotating schedule? Yes No

1. What is your favorite fast food restaurant?

• McDonald's
• Wendy's
• Burger King
• Krystal
• Chick-fil-a
• Taco Bell
• Kentucky Fried Chicken
• Arby's
• Hardee's
• Other

1. How many times do you eat out per week?

Never 1 time 2-3 times 4-5 times 6-7 times

2. How many times do you eat at a fast food restaurant per week?

Never 1 time 2-3 times 4-5 times 6-7 times

3. Would you rather eat out or at home? Eat Out Eat at Home
4. Do you think it is healthier to eat out or to eat at home?

Out Home Both are the same

1. Approximately how many hours do you spend watching TV on a weekday?

1 or less

2­3 hrs

3 or more hours

2. Approximately how many hours do you spend watching TV on Saturday?

1 or less

2­3 hrs

3 or more hours

3. Approximately how many hours do you spend watching TV on Sunday?

1 or less

2­3 hrs

3 or more hours

4. How many TV's are in your house?

0-1

2­3

4 or more

5. Why do you watch TV?

to relax

to gain knowledge

to be entertained

other (explain)

6. Do your parents limit the amount of TV you can watch?

yes

no

7. Do your parents limit your TV watching as a punishment?

yes

no

8. Do you have your own TV in your room?

yes

no

9. Do you watch TV when you do your homework?

yes

no

10. Does your family watch TV during meals?

yes

no

11. What is your favorite TV show?

12. What is the best movie you ever saw on TV?

1. Approximately how many hours do you spend using the computer on a weekday?

1 or less

2­3 hrs

3 or more hours

2. Approximately how many hours do you spend using the computer on Saturday?

1 or less

2­3 hrs

3 or more hours

3. Approximately how many hours do you spend using the computer on Sunday?

1 or less

2­3 hrs

3 or more hours

4. How many computers are in your house?

0-1

2­3

4 or more

5. Why do you use the computer?

to play games

to gain knowledge

to do homework

other (explain)

6. Do your parents limit the amount of computer time you can have?

yes

no

7. Do your parents limit your computer use as a punishment?

yes

no

8. Do you have your own computer in your room?

yes

no

9. Do you use the computer to do your homework?

yes

no

10. Do other members of your family use the computer?

yes

no

11. What is your favorite thing to do on the computer?

12. What is the best computer program?