FFVP CFD Pilot - Individual

Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP

Appendix E3c. STUDENT SURVEY

OMB Control No: 0584-XXXX

Expiration date: XX/XX/XXXX

For office use only

ID: _______________

What Do Students Eat?

Please answer the questions below by checking the box or filling in the blanks.

 This is not a test! There are no right or wrong answers. We want to know about you and what you like to eat.

1. In a usual school week (weekdays), how often do you eat the following school meals? Mark only ONE box for each statement.
	Less than once a week or never	1 to 2 times a week	3 to 4 times a week	Every day
I usually eat the school lunch…	1	2	3	4
B. I usually bring lunch from home…	1	2	3	4
C. I usually eat the school breakfast….	1	2	3	4

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Your school offers free fruit and vegetable snacks BETWEEN meals.

2. When they are offered, how often do you usually take the free FRUIT snack? Mark only ONE box.
	1	Every time offered
	2	Most times offered
	3	Occasionally
	4	Never
	5	Haven’t seen it offered
3. When they are offered, how often would you take the free VEGETABLE snack? Mark only ONE box.
	1	Every time offered
	2	Most times offered
	3	Occasionally
	4	Never
	5	Haven’t seen it offered
4. If you take the free FRUIT snack when it is offered, how much of it do you usually eat? Mark only ONE box.
	1	I usually eat all of it
	2	I 4a. Why don’t you eat the FRUIT snack? Check ALL that apply  Don’t like the kind of fruit  Don’t like the taste of fruit  Don’t like the way it looks  Don’t have time to eat it  Other (please describe) __________________ usually eat most of it
	3	I usually eat some of it
	4	I don’t usually eat any of it
	5	I don’t usually take the free fruit

5. If you take the free VEGETABLE snack when it is offered, how much of it do you usually eat? Mark only ONE box.
	1	I usually eat all of it
	2	I 5a. Why don’t you eat the FRUIT snack? Check ALL that apply  Don’t like the kind of fruit  Don’t like the taste of fruit  Don’t like the way it looks  Don’t have time to eat it  Other (please describe) __________________ usually eat most of it
	3	I usually eat some of it
	4	I don’t usually eat any of it
	5	I don’t usually take the free vegetable

6. If you do not take the fruit or vegetable snacks when they are offered, why not? Check ALL that apply.
	1	I already take them every time they are offered
	2	I don’t like fruits
	3	I don’t like vegetables
	4	I’m not hungry when they are offered
	5	I don’t like the look of the fruits and vegetables offered
	6	I’m not in the class during snack time

6a. Have you heard or seen any information around school about the free fruit and vegetable snacks? Mark only ONE box.
	1	Yes, Go to 6b
	2	No If no, skip to question 7

6b. If you answered yes to question 6a, where did you see or hear the information? Check ALL that apply.
	1	School cafeteria staff
	2	Announcement over the loud speaker
	3	Poster around school
	4	Teacher/classroom
	5	Other (please describe where) __________________________________

7. How much do you agree or disagree with the following statements? Mark only ONE box for each statement.
	I agree very much 	I agree a little 	I disagree a little 	I disagree a lot 
A. I eat more fruits and vegetables on days when free fruit and vegetable snacks are given at school than on other days	1	2	3	4
B. The free fruits and vegetables they give us for school snacks look good and taste good.	1	2	3	4
C. I wish they would give us different kinds of fruits and vegetables to eat for school snacks.	1	2	3	4
D. On days when I eat a free fruit or a vegetable snack at school, I don’t eat other kinds of snacks.	1	2	3	4
E. I hope the free fruit and vegetable snacks continue at our school.	1	2	3	4

8. How much do you agree or disagree with each of the following statements? Mark only ONE box for each statement.
	I agree very much 	I agree a little 	I disagree a little 	I disagree a lot 
A. I like most fruits	1	2	3	4
B. I like most vegetables	1	2	3	4
C. I like to try new kinds of fruits	1	2	3	4
D. I like to try new kinds of vegetables	1	2	3	4

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9. For each fresh fruit or vegetable, mark how much you like it. Even if you can’t eat one of these foods now (for example, you have braces or some other reason) answer whether you like or don’t like it. Mark only ONE box for each fruit or vegetable.
		Like a lot 	Like a little 	Don’t like it 	Don’t Know Never tasted
A. Apples		1	2	3	4
B. Bananas		1	2	3	4
C. Strawberries		1	2	3	4
D. Kiwi Fruits		1	2	3	4
E. Oranges		1	2	3	4
F. Pears		1	2	3	4
G. Grapes		1	2	3	4
H. Cantaloupe		1	2	3	4
I. Peaches		1	2	3	4
J. Pineapple		1	2	3	4
K. Plums		1	2	3	4
L. Watermelon		1	2	3	4
M. Nectarines		1	2	3	4

9. Continued For each fresh fruit or vegetable, mark how much you like it. Mark only ONE box for each fruit or vegetable.
		Like a lot 	Like a little 	Don’t like it 	Don’t Know Never tasted
N. Blueberries		1	2	3	4
O. Tomatoes		1	2	3	4
P. Carrots		1	2	3	4
Q. Bell peppers		1	2	3	4
R. Zucchini		1	2	3	4
S. Celery		1	2	3	4
T. Broccoli		1	2	3	4
U. Cauliflower		1	2	3	4
V. Cucumbers		1	2	3	4
W. Lettuce		1	2	3	4
X. Snow peas		1	2	3	4

9. VERSION FOR SPRING: For each fruit or vegetable, mark how much you like it. Even if you can’t eat one of these foods now (for example, you have braces or some other reason) answer whether you like or don’t like it. Mark only ONE box for each fruit or vegetable.
		Like a lot 	Like a little 	Don’t like it 	Don’t Know Never tasted
A. Applesauce		1	2	3	4
B. Dried apples		1	2	3	4
C. Dried apricots		1	2	3	4
D. Dates		1	2	3	4
E. Canned oranges		1	2	3	4
F. Canned pears		1	2	3	4
G. Raisins		1	2	3	4
H. Canned peaches		1	2	3	4
I. Canned pineapple		1	2	3	4
J. Dried plums		1	2	3	4

9. Continued For each fruit or vegetable, mark how much you like it. Mark only ONE box for each fruit or vegetable.
		Like a lot 	Like a little 	Don’t like it 	Don’t Know Never tasted
K. Cooked carrots		1	2	3	4
L. Roasted peppers		1	2	3	4
M. Cooked zucchini		1	2	3	4
N. Cooked broccoli		1	2	3	4
O. Cooked cauliflower		1	2	3	4

You are nearly finished! Just one question about you…

10. What language do you use with your parents most of the time?

₁ English

₂ Spanish

₃ Sometimes English and sometimes Spanish

₃ Other (please describe) ________________________________________

Thank you for your help with this questionnaire!

E.3c.9