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Digital Nutrition Education Materials for Middle School Teachers (SLT) - IC 1 of 2
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Digital Nutrition Education Materials for Middle School Teachers (SLT) - IC 1 of 2 |
| Author | Gerad O'Shea |
| Last Modified By | Writer |
| File Modified | 2017-02-22 |
| File Created | 2026-10-03 |
| Conversion State | complete |
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Name: ________________ Date: _________________ Teacher: _______________Attachment D - Student Survey: Grade 6 Section One: What Do you eat and Drink? The questions in this section ask about the food you ate over the past week. Please think about what you ate during the past week, while you were at school, and while you were not at school. Not at school includes all of the rest of the time, for example, when you are at home, at a friend's house, or at a restaurant. You are going to mark the column that shows, on average, how many times you ate the food at school and not at school. If you did not eat this food or drink this beverage during the past week, please mark "never or less than 1 per week." 1a. Type of Drink Location Never or less than 1 per week 1 per week 2-4 per week 5-6 per week 1 per day 2-3 per day 4+ per day Orange juice, apple juice and other 100% juices At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Fruit drinks (such as Snapple, flavored teas, Capri Sun and Kool-Aid) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Sport drinks (such as Gatorade or PowerAde) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Flavored waters such as Propel or vitamin waters At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Unflavored bottled water, tap water, water from a drinking fountain, or other unflavored water At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Diet soda or pop (include all kinds such as Diet Pepsi, Pepsi One, Diet Coke, Diet 7-Up) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Regular soda or pop (include all kinds such as Coke, Pepsi, 7-Up, Sprite, root beer) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Energy Drinks (such as Rockstar, Red Bull, Monster and Full Throttle) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ 1% or nonfat milk (sometimes called skim, fat-free, or low-fat milk; includes white and chocolate) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Regular or 2% milk (sometimes called whole, reduced fat, or 4% milk; includes white and chocolate) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ 1b. Type of Food Location Never or less than 1 per week 1 per week 2-4 per week 5-6 per week 1 per day 2-3 per day 4+ per day Low-fat or non-fat potato chips, tortilla chips, and corn chips (such as Baked Lays, Reduced-fat Doritos, Fat-Free Pringles) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Regular potato chips, tortilla chips, corn chips, and puffs (such as Ruffles, Lay's, Pringles, Doritos, Fritos, Cheetos) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Other salty snacks (like cheese nibs, Chex Mix, gold fish crackers, Ritz Bits) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Candy, including chocolate, candy bars, jelly bellies, gummies and Lifesavers (do not include cookies) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Doughnuts, pop tarts, or other breakfast pastries At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Cookies, brownies, pies, and cakes At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Low or nonfat frozen desserts such as low fat ice cream, frozen yogurt, popsicles, & sherbet At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Regular ice cream & milkshakes (include all flavors) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Whole grain cereals At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ How often did you eat a serving of vegetables such as green salad, peas, green beans, or corn? (do not count fried potatoes or French fries) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ How often did you eat a serving of fruit such as a banana, apple, or grapes? (do not count juices) At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ How often did you eat any breakfast? At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ How often did you eat breakfast that contained at least 3 food groups? At School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Not at School ☐ ☐ ☐ ☐ ☐ ☐ ☐ Section Two: What do you think? 2a. Please list the five food groups below 2b. For each food group at left, please name one common nutrient found in foods from that food group 1) _____________________________ 1) _______________________________ 2) _____________________________ 2) _______________________________ 3) _____________________________ 3) _______________________________ 4) _____________________________ 4) _______________________________ 5) _____________________________ 5) _______________________________ Please describe three healthy breakfast options that include at least 3 different food groups 3a. Name & describe three balanced breakfasts below 3b. Name the food groups in each meal Food Group 1 Food Group 2 Food Group 3 Breakfast 1: Breakfast 2: Breakfast 3: 4. Attitudes about Breakfast Strongly Agree Agree Disagree Strongly Disagree It is difficult for me to find time to eat breakfast every morning. ☐ ☐ ☐ ☐ It is difficult for me to find healthy breakfast options at home. ☐ ☐ ☐ ☐ It is difficult for me to find healthy breakfast options at school. ☐ ☐ ☐ ☐ Eating a balanced, nutritious breakfast can help me focus in class. ☐ ☐ ☐ ☐ In the space below, please describe how you can use MyPlate to build a healthy breakfast: