MCUSD PEP 3rd-8th Fruits and Vegetable Survey #3 Question Title * 1. NAME Question Title * 2. AGE Question Title * 3. GRADE 1st 2nd 3rd 4th 5th 6th 7th 8th Question Title * 4. SCHOOL Highland Monroe Center Meridian Junior High Question Title * 5. Yesterday, did you eat fruit? (Count all fresh, canned or dried fruit) (DO NOT COUNT FRUIT JUICE) No, I didn't eat any fruit yesterday. Yes, I ate fruit 1 time yesterday. Yes, I ate fruit 2 times yesterday. Yes, I ate fruit 3 times yesterday. Yes, I ate fruit 4 times yesterday.l Yes, I ate fruit 5 or more times yesterday. Question Title * 6. Yesterday, did you eat a salad made with lettuce, or any green vegetables like spinach, green beans, broccoli, or other greens? No, I didn't eat any salad or green vegetables yesterday. Yes, I ate salad or green vegetables 1 time yesterday. Yes, I ate salad or green vegetables 2 times yesterday. Yes, I ate salad or green vegetables 3 times yesterday. Yes, I ate salad or green vegetables 4 times yesterday.l Yes, I ate salad or green vegetables 5 or more times yesterday. Question Title * 7. Yesterday, did you eat any starchy vegetables like potatoes, corn, or peas? DO NOT COUNT FRENCH FRIES or CHIPS. No, I didn't eat any of the foods listed above yesterday. Yes, I ate one of these foods 1 time yesterday. Yes, I ate one of these foods 2 times yesterday. Yes, I ate one of these foods 3 or more times yesterday. Question Title * 8. Yesterday, did you eat any orange vegetables like carrots, squash, or sweet potatoes? No, I didn't eat any orange vegetables yesterday. Yes, I ate orange vegetables 1 time yesterday. Yes, I ate orange vegetables 2 times yesterday. Yes, I ate orange vegetables 3 times yesterday. Yes, I ate orange vegetables 4 times yesterday. Yes, I ate orange vegetables 5 or more times yesterday. Question Title * 9. Yesterday, did you eat any other vegetables like peppers, tomatoes, zucchini, asparagus, cabbage, cauliflower, cucumbers, mushrooms, eggplant, celery, or artichokes? No, I didn't eat any of the foods listed above yesterday. Yes, I ate one of these foods 1 time yesterday. Yes, I ater one of these foods 2 times yesterday. Yes, I ate one of these foods 3 times yesterday. Yes I ate one of these foods 4 times yesterday. Yes, I ate one of these foods 5 or more times yesterday. Done