FFVP-CFD_Appendix_D1_NutritionEducationPromotion_Menu

Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP
Appendix D.1 NUTRITION EDUCATION, PROMOTIONAL MATERIAL AND MENU COLLECTION FORM
			OMB Control No: 0584-XXXX
			Expiration date: XX/XX/XXXX
FRUITS AND VEGETABLES PROGRAM - SCHOOL- LEVEL NUTRITION EDUCATION AND PROMOTION MATERIAL AND MENU COLLECTION FORM
1.	Your Name:
2.	Name of School:
3.	Target Week Dates:	From ____/____/20___ To ____/____/20___
4.	Please staple a copy of the school menu for the target week.			Check box if attached
5.	Please mark all nutrition education activities and nutrition promotion materials present in the cafeteria, in column A. Then for each type of material that is present, please answer column B.
	A.	B.
	What types of nutrition education activities and nutrition promotion materials are present? Mark all that apply	Are the materials related to fruits and/or vegetables?
	□ Nutrition poster	□ Yes	□ No
	□ Nutrition display	□ Yes	□ No
	□ Staff encouraging students to consume fruits or vegetables	□ Yes	□ No
	□ Taste testing	□ Yes	□ No
	□ Other _______________	□ Yes	□ No
	□ None
	□ Not applicable
6.	Please mark all nutrition education and nutrition promotion materials present in other food service areas, in column A. Then for each type of material that is present, please answer column B.
	A.	B.
	What types of nutrition promotion materials are present? Mark all that apply	Are the materials related to fruits and/or vegetables?
	□ Nutrition poster	□ Yes	□ No
	□ Nutrition display	□ Yes	□ No
	□ Other _______________	□ Yes	□ No
	□ None
	□ Not applicable