Nutrition Assessment

Dear Student
Nutrition is a very important part of our program. In order for us to plan appropriate nutrition-education activates and menus to meet your needs. We need to know your eating patterns. This information will also help us obtain an overview of the eating habits of young children as a group. Please take the time to fill out the questionnaire carefully.
Your name box starts with the first four letters of your last name, a space, then the period (R2, G5 or G6) Example: Mill R2
Name: 


  1. How many days a week do you eat a morning meal?


  1. How many days a week do you eat lunch?


  1. How many days a week do you eat a evening meal?


  1. How many days a week do you eat a midmorning snack?


  1. How many days a week do you eat a midafternoon snack?


  1. How many days a week do you eat an evening snack?


  1. When are you most hungry (morning, noon or evening)?


  1. What are some of your favorite foods?


  1. What foods do you dislike?


  1. Are you taking vitamin or mineral supplements?


  1. Do you have dental problems causing you not to eat certain foods?


  1. Are you taking any medications which are diet related?


  1. How much water do you drink throughout the day?





Coach Schwartz
Physical Education Teacher
Lejeune High School