Contact: Michigan State University Extension
Name:
What is your age?
What is your grade?
Date:
Are you a (check): ___Boy ___Girl
OPTIONAL: What is your ethnicity (check all that apply):
___African American/Black
___Asian
___Hispanic/Latino
___Native American
___Caucasian/White
___Other:
1. From which food group should you eat the most servings per day?
___Vegetable group
___Bread, cereal, rice and pasta group
___Fruit group
___Meat, poultry, fish, dry beans, eggs and nut group
___Milk group
___Fats, oils and sweet group
2. Check the food in each line which has more fat
___pretzels or ___potato chips
___hamburgers or ___cheeseburger
___French fries or ___baked potato
___beef burrito or ___bean burrito
___cracker or ___cookie
3. What can we learn from the Food Guide Pyramid?
___The different cost of foods
___Where to find healthy foods
___How much to eat of different kinds of foods
___Which foods come from plants and which from animals
___I have never seen the Food Guide Pyramid and don't know
4. Eggs and beans belong in which food group?
___Vegetable group
___Bread, cereal, rice and pasta group
___Fruit group
___Meat, poultry, fish, dry beans, eggs and nut group
___Milk group
___Fats, oils and sweets group
___I am not sure
Circle the number that best describes what you do. The numbers mean:
1 - never
2 - hardly ever
3 - sometimes
4 - most of the time
5 - always
6 - don't know
| 5. I eat foods from all the food groups everyday. |
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6 |
| 6. I make snacks and meals for myself. | 1 | 2 | 3 | 4 | 5 | 6 |
| 7. I try foods that I have never eaten before. | 1 | 2 | 3 | 4 | 5 | 6 |
| 8. I eat candy or chips, such as potato chips, tortilla chips or corn chips everyday. | 1 | 2 | 3 | 4 | 5 | 6 |
| 9. I drink soda pop everyday. | 1 | 2 | 3 | 4 | 5 | 6 |
| 10. I read the "Nutrition Facts" food label on the foods I eat. | 1 | 2 | 3 | 4 | 5 | 6 |
| 11. I think about the foods I eat and how they help my body grow and be healthy. | 1 | 2 | 3 | 4 | 5 | 6 |
| 12. I drink milk or eat cheese at least two times a day. | 1 | 2 | 3 | 4 | 5 | 6 |
| 13. I eat breakfast everyday. | 1 | 2 | 3 | 4 | 5 | 6 |
| 14. I eat lunch everyday. | 1 | 2 | 3 | 4 | 5 | 6 |
| 15. I eat fruits or drink 100% fruit juice twice a day. | 1 | 2 | 3 | 4 | 5 | 6 |
| 16. I eat vegetables everyday. | 1 | 2 | 3 | 4 | 5 | 6 |
| 17. I keep cold foods, like a sandwich or milk, cold until I eat or drink them. | 1 | 2 | 3 | 4 | 5 | 6 |
| 18. I wash my hands with warm water and soap before eating meals. | 1 | 2 | 3 | 4 | 5 | 6 |
| 19. I walk, run, bike or skate at least three times per week. | 1 | 2 | 3 | 4 | 5 | 6 |
ENTRY DATE:: January 1999
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