Independence Charter School

Complete the survey below.

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* 1. Please choose your grade level:

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* 2. For Breakfast Out of 5 school days each week, on average how many days do you do each of the following for breakfast? Your total must add to 5.

Get breakfast at school

Buy breakfast on your way to school

Bring breakfast form home to eat at school

Eat breakfast at home

Skip Breakfast

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* 3. From the list below, please select up to 3 top reasons why you don't get breakfast at school more often.

Too expensive

School doesn't offer breakfast food I like

Not enough time before class to get breakfast

Cafeteria's location is not convenient

I am not hungry

I'd rather spend the time with my friends; they don't eat breakfast at school

School breakfast isn't healthy fresh

School breakfast doesn't look good

Other (please specify)

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* 4. How many days a week do you eat breakfast at the school?

1-2

3-4

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* 5. If you never eat breakfast at the school, or only eat it 1-2 times a week, why?

I bring my breakfast/I eat breakfast at home

I do not eat breakfast

My bus is always late

I do not like what the cafeteria offers

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* 6. For Breakfast select the statement that fits each type of food.

	I would like to see MORE of these items offered	I would like to see LESS of these items offered
Hot breakfast sandwiches	Hot breakfast sandwiches I would like to see MORE of these items offered	Hot breakfast sandwiches I would like to see LESS of these items offered
Cold Cereal	Cold Cereal I would like to see MORE of these items offered	Cold Cereal I would like to see LESS of these items offered
Hot Cereal	Hot Cereal I would like to see MORE of these items offered	Hot Cereal I would like to see LESS of these items offered
Bagels	Bagels I would like to see MORE of these items offered	Bagels I would like to see LESS of these items offered
Fruit	Fruit I would like to see MORE of these items offered	Fruit I would like to see LESS of these items offered
Eggs	Eggs I would like to see MORE of these items offered	Eggs I would like to see LESS of these items offered
Pancakes	Pancakes I would like to see MORE of these items offered	Pancakes I would like to see LESS of these items offered
Waffles	Waffles I would like to see MORE of these items offered	Waffles I would like to see LESS of these items offered
French Toast	French Toast I would like to see MORE of these items offered	French Toast I would like to see LESS of these items offered
Turkey Bacon, Sausage, etc	Turkey Bacon, Sausage, etc I would like to see MORE of these items offered	Turkey Bacon, Sausage, etc I would like to see LESS of these items offered
Granola bars	Granola bars I would like to see MORE of these items offered	Granola bars I would like to see LESS of these items offered
Yogurt	Yogurt I would like to see MORE of these items offered	Yogurt I would like to see LESS of these items offered

Other (please specify)

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* 7. If breakfast items you like the most were offered, how many days per week would you get breakfast at school?

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* 8. Please answer the following about the different locations where breakfast may be available at your school:

	Breakfast is available at this location	I would get breakfast at this location if it was available
In School Cafeteria	In School Cafeteria Breakfast is available at this location	In School Cafeteria I would get breakfast at this location if it was available
Breakfast in classroom	Breakfast in classroom Breakfast is available at this location	Breakfast in classroom I would get breakfast at this location if it was available
Grab-n-go cart at the entrance or other location	Grab-n-go cart at the entrance or other location Breakfast is available at this location	Grab-n-go cart at the entrance or other location I would get breakfast at this location if it was available

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* 9. What is your favorite fruit? (Check all that apply)

Apple

Orange

Grape

Pear

Banana

Peach

Plum

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* 10. For Lunch Out of 5 school days each week, on average, how many days do you do each of the following for lunch? Your total must add to 5.

Get lunch at school cafeteria

Bring lunch from home to
eat at school

Leave school to buy lunch

Skip Lunch

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* 11. How many days a week do you eat at the lunch served at school?

1-2

3-4

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* 12. If you never eat lunch served at school, or only eat it 1-2 times a week, why?

I bring my lunch from home

I skip lunch

I do not like what the cafeteria offers

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* 13. When you decide whether or not to get lunch at school, how important are each of the following to your decision?

	5- Very Important	4- Important	3- Somewhat Important	2- Not Very Important	1- Not Important At All
Menu variety	Menu variety 5- Very Important	Menu variety 4- Important	Menu variety 3- Somewhat Important	Menu variety 2- Not Very Important	Menu variety 1- Not Important At All
Salad and sandwich options	Salad and sandwich options 5- Very Important	Salad and sandwich options 4- Important	Salad and sandwich options 3- Somewhat Important	Salad and sandwich options 2- Not Very Important	Salad and sandwich options 1- Not Important At All
Ability to customize or "build your own meal"	Ability to customize or "build your own meal" 5- Very Important	Ability to customize or "build your own meal" 4- Important	Ability to customize or "build your own meal" 3- Somewhat Important	Ability to customize or "build your own meal" 2- Not Very Important	Ability to customize or "build your own meal" 1- Not Important At All
Fresh menu ingredients	Fresh menu ingredients 5- Very Important	Fresh menu ingredients 4- Important	Fresh menu ingredients 3- Somewhat Important	Fresh menu ingredients 2- Not Very Important	Fresh menu ingredients 1- Not Important At All
Taste of food	Taste of food 5- Very Important	Taste of food 4- Important	Taste of food 3- Somewhat Important	Taste of food 2- Not Very Important	Taste of food 1- Not Important At All
Appearance of food	Appearance of food 5- Very Important	Appearance of food 4- Important	Appearance of food 3- Somewhat Important	Appearance of food 2- Not Very Important	Appearance of food 1- Not Important At All

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* 14. What would encourage you to participate in lunch more often?

Shorter lines

Different hot menu choices

Different cold menu choices

Other (please specify)

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* 15. Now for the same list rate how well your school cafeteria does for each.

	5- Excellent	4-Very Good	3- Average	2- Fair	1- Poor
Menu variety	Menu variety 5- Excellent	Menu variety 4-Very Good	Menu variety 3- Average	Menu variety 2- Fair	Menu variety 1- Poor
Ability to customize or "build your own meal"	Ability to customize or "build your own meal" 5- Excellent	Ability to customize or "build your own meal" 4-Very Good	Ability to customize or "build your own meal" 3- Average	Ability to customize or "build your own meal" 2- Fair	Ability to customize or "build your own meal" 1- Poor
Fresh menu items/ingredients	Fresh menu items/ingredients 5- Excellent	Fresh menu items/ingredients 4-Very Good	Fresh menu items/ingredients 3- Average	Fresh menu items/ingredients 2- Fair	Fresh menu items/ingredients 1- Poor
Taste of food	Taste of food 5- Excellent	Taste of food 4-Very Good	Taste of food 3- Average	Taste of food 2- Fair	Taste of food 1- Poor
Appearance of food	Appearance of food 5- Excellent	Appearance of food 4-Very Good	Appearance of food 3- Average	Appearance of food 2- Fair	Appearance of food 1- Poor
Place to learn about healthy eating habits	Place to learn about healthy eating habits 5- Excellent	Place to learn about healthy eating habits 4-Very Good	Place to learn about healthy eating habits 3- Average	Place to learn about healthy eating habits 2- Fair	Place to learn about healthy eating habits 1- Poor
Fun place to eat/socialize	Fun place to eat/socialize 5- Excellent	Fun place to eat/socialize 4-Very Good	Fun place to eat/socialize 3- Average	Fun place to eat/socialize 2- Fair	Fun place to eat/socialize 1- Poor
Conveniently located cafeteria	Conveniently located cafeteria 5- Excellent	Conveniently located cafeteria 4-Very Good	Conveniently located cafeteria 3- Average	Conveniently located cafeteria 2- Fair	Conveniently located cafeteria 1- Poor
Clean cafeteria	Clean cafeteria 5- Excellent	Clean cafeteria 4-Very Good	Clean cafeteria 3- Average	Clean cafeteria 2- Fair	Clean cafeteria 1- Poor

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* 16. What is your overall satisfaction level with each of these items served in your school cafeteria?

	5- Very Satisfied	4- Satisfied	3- Somewhat Satisfied	2- Not Very Satisfied	1- Not Satisfied at all	0- I Don't Eat it
Tacos/Burritos	Tacos/Burritos 5- Very Satisfied	Tacos/Burritos 4- Satisfied	Tacos/Burritos 3- Somewhat Satisfied	Tacos/Burritos 2- Not Very Satisfied	Tacos/Burritos 1- Not Satisfied at all	Tacos/Burritos 0- I Don't Eat it
Cold Sandwiches (deli, cold cuts, wraps etc.)	Cold Sandwiches (deli, cold cuts, wraps etc.) 5- Very Satisfied	Cold Sandwiches (deli, cold cuts, wraps etc.) 4- Satisfied	Cold Sandwiches (deli, cold cuts, wraps etc.) 3- Somewhat Satisfied	Cold Sandwiches (deli, cold cuts, wraps etc.) 2- Not Very Satisfied	Cold Sandwiches (deli, cold cuts, wraps etc.) 1- Not Satisfied at all	Cold Sandwiches (deli, cold cuts, wraps etc.) 0- I Don't Eat it
Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.)	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 5- Very Satisfied	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 4- Satisfied	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 3- Somewhat Satisfied	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 2- Not Very Satisfied	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 1- Not Satisfied at all	Hot Sandwiches (cheese steak, grilled cheese, meatball subs etc.) 0- I Don't Eat it
Burgers	Burgers 5- Very Satisfied	Burgers 4- Satisfied	Burgers 3- Somewhat Satisfied	Burgers 2- Not Very Satisfied	Burgers 1- Not Satisfied at all	Burgers 0- I Don't Eat it
Pizza	Pizza 5- Very Satisfied	Pizza 4- Satisfied	Pizza 3- Somewhat Satisfied	Pizza 2- Not Very Satisfied	Pizza 1- Not Satisfied at all	Pizza 0- I Don't Eat it
Pasta Dishes (mac n cheese, spaghetti, lasagna	Pasta Dishes (mac n cheese, spaghetti, lasagna 5- Very Satisfied	Pasta Dishes (mac n cheese, spaghetti, lasagna 4- Satisfied	Pasta Dishes (mac n cheese, spaghetti, lasagna 3- Somewhat Satisfied	Pasta Dishes (mac n cheese, spaghetti, lasagna 2- Not Very Satisfied	Pasta Dishes (mac n cheese, spaghetti, lasagna 1- Not Satisfied at all	Pasta Dishes (mac n cheese, spaghetti, lasagna 0- I Don't Eat it
Chicken nuggets/tenders	Chicken nuggets/tenders 5- Very Satisfied	Chicken nuggets/tenders 4- Satisfied	Chicken nuggets/tenders 3- Somewhat Satisfied	Chicken nuggets/tenders 2- Not Very Satisfied	Chicken nuggets/tenders 1- Not Satisfied at all	Chicken nuggets/tenders 0- I Don't Eat it
Chicken patty sandwiches	Chicken patty sandwiches 5- Very Satisfied	Chicken patty sandwiches 4- Satisfied	Chicken patty sandwiches 3- Somewhat Satisfied	Chicken patty sandwiches 2- Not Very Satisfied	Chicken patty sandwiches 1- Not Satisfied at all	Chicken patty sandwiches 0- I Don't Eat it
Salads	Salads 5- Very Satisfied	Salads 4- Satisfied	Salads 3- Somewhat Satisfied	Salads 2- Not Very Satisfied	Salads 1- Not Satisfied at all	Salads 0- I Don't Eat it

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* 17. What is your favorite lunch item?

Salads

Cold sandwiches

Hot sandwiches (hamburger, Chicken Patty)

Pizza

Pasta meals (Lasagna, Pasta & Meatballs, Mac & Cheese, Baked Ziti)

Empanadas, Quesadilla, Tacos. Burritos

Meat/Chicken (Chili, Salisbury Steak, BBQ Chicken,)

Fish Meals (Baked Cajun Fish, Fish & Chips, Fish Nuggets)

Teriyaki Meatballs, Tangerine Chicken, Asian Noodles

Other (please specify)

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* 18. What is your favorite vegetable? (Check all that apply)

Carrots

Corn

Lettuce

Broccoli

Green Beans

Spinach

Collard Greens

Sweet Potatoes

Peas

Cauliflower

Lima Beans

Black Beans

Chickpeas

Lentils

Celery

Cucumbers

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* 19. What is your favorite fruit? (Check all that apply)

Apple

Orange

Grape

Pear

Banana

Peach

Plum

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* 20. When you decide to whether or not to get breakfast or lunch at school, how important are each of the
following to your decision?

	5-Very Important	4-Important	3-Somewhat Important	2-Not Very Important	1-Not Important at All
Shorter lines	Shorter lines 5-Very Important	Shorter lines 4-Important	Shorter lines 3-Somewhat Important	Shorter lines 2-Not Very Important	Shorter lines 1-Not Important at All
Friendly cafeteria staff	Friendly cafeteria staff 5-Very Important	Friendly cafeteria staff 4-Important	Friendly cafeteria staff 3-Somewhat Important	Friendly cafeteria staff 2-Not Very Important	Friendly cafeteria staff 1-Not Important at All
Place to learn about healthy eating habits	Place to learn about healthy eating habits 5-Very Important	Place to learn about healthy eating habits 4-Important	Place to learn about healthy eating habits 3-Somewhat Important	Place to learn about healthy eating habits 2-Not Very Important	Place to learn about healthy eating habits 1-Not Important at All
Fun place to eat/socialize	Fun place to eat/socialize 5-Very Important	Fun place to eat/socialize 4-Important	Fun place to eat/socialize 3-Somewhat Important	Fun place to eat/socialize 2-Not Very Important	Fun place to eat/socialize 1-Not Important at All
Conveniently located cafeteria	Conveniently located cafeteria 5-Very Important	Conveniently located cafeteria 4-Important	Conveniently located cafeteria 3-Somewhat Important	Conveniently located cafeteria 2-Not Very Important	Conveniently located cafeteria 1-Not Important at All
Clean cafeteria	Clean cafeteria 5-Very Important	Clean cafeteria 4-Important	Clean cafeteria 3-Somewhat Important	Clean cafeteria 2-Not Very Important	Clean cafeteria 1-Not Important at All

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* 21. Tell us how much you agree or disagree with the statements about school breakfast or lunch this year.

	Strongly Agree	Agree	Disagree	Strongly Disagree
Meals are prepared fresh.	Meals are prepared fresh. Strongly Agree	Meals are prepared fresh. Agree	Meals are prepared fresh. Disagree	Meals are prepared fresh. Strongly Disagree	Meals are prepared fresh.
Meals are tasty.	Meals are tasty. Strongly Agree	Meals are tasty. Agree	Meals are tasty. Disagree	Meals are tasty. Strongly Disagree	Meals are tasty.
I am willing to try foods I haven't tried before.	I am willing to try foods I haven't tried before. Strongly Agree	I am willing to try foods I haven't tried before. Agree	I am willing to try foods I haven't tried before. Disagree	I am willing to try foods I haven't tried before. Strongly Disagree	I am willing to try foods I haven't tried before.
The cafeteria staff is polite and helpful.	The cafeteria staff is polite and helpful. Strongly Agree	The cafeteria staff is polite and helpful. Agree	The cafeteria staff is polite and helpful. Disagree	The cafeteria staff is polite and helpful. Strongly Disagree	The cafeteria staff is polite and helpful.
Meal service by the staff is good.	Meal service by the staff is good. Strongly Agree	Meal service by the staff is good. Agree	Meal service by the staff is good. Disagree	Meal service by the staff is good. Strongly Disagree	Meal service by the staff is good.
Meals match what is indicated on the menu.	Meals match what is indicated on the menu. Strongly Agree	Meals match what is indicated on the menu. Agree	Meals match what is indicated on the menu. Disagree	Meals match what is indicated on the menu. Strongly Disagree	Meals match what is indicated on the menu.
I have enough time to eat.	I have enough time to eat. Strongly Agree	I have enough time to eat. Agree	I have enough time to eat. Disagree	I have enough time to eat. Strongly Disagree	I have enough time to eat.

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* 22. Now for the same list rate how well your school cafeteria does for each.

	5- Excellent	4-Very Good	3- Average	2- Fair	1- Poor
Place to learn about healthy eating habits	Place to learn about healthy eating habits 5- Excellent	Place to learn about healthy eating habits 4-Very Good	Place to learn about healthy eating habits 3- Average	Place to learn about healthy eating habits 2- Fair	Place to learn about healthy eating habits 1- Poor
Fun place to eat/socialize	Fun place to eat/socialize 5- Excellent	Fun place to eat/socialize 4-Very Good	Fun place to eat/socialize 3- Average	Fun place to eat/socialize 2- Fair	Fun place to eat/socialize 1- Poor
Conveniently located cafeteria	Conveniently located cafeteria 5- Excellent	Conveniently located cafeteria 4-Very Good	Conveniently located cafeteria 3- Average	Conveniently located cafeteria 2- Fair	Conveniently located cafeteria 1- Poor
Clean Cafeteria	Clean Cafeteria 5- Excellent	Clean Cafeteria 4-Very Good	Clean Cafeteria 3- Average	Clean Cafeteria 2- Fair	Clean Cafeteria 1- Poor
Shorter lines	Shorter lines 5- Excellent	Shorter lines 4-Very Good	Shorter lines 3- Average	Shorter lines 2- Fair	Shorter lines 1- Poor
Friendly cafeteria staff	Friendly cafeteria staff 5- Excellent	Friendly cafeteria staff 4-Very Good	Friendly cafeteria staff 3- Average	Friendly cafeteria staff 2- Fair	Friendly cafeteria staff 1- Poor

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* 23. Using stars from 1 to 10, where 1 is the worst school cafeteria possible and 10 is the best school
cafeteria possible, how many stars would you give your school cafeteria?

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* 1. Please choose your grade level:

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* 2. For Breakfast Out of 5 school days each week, on average how many days do you do each of the following for breakfast? Your total must add to 5.

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* 3. From the list below, please select up to 3 top reasons why you don't get breakfast at school more often.

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* 4. How many days a week do you eat breakfast at the school?

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* 5. If you never eat breakfast at the school, or only eat it 1-2 times a week, why?

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* 6. For Breakfast select the statement that fits each type of food.

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* 7. If breakfast items you like the most were offered, how many days per week would you get breakfast at school?

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* 8. Please answer the following about the different locations where breakfast may be available at your school:

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* 9. What is your favorite fruit? (Check all that apply)

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* 10. For Lunch Out of 5 school days each week, on average, how many days do you do each of the following for lunch? Your total must add to 5.

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* 11. How many days a week do you eat at the lunch served at school?

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* 12. If you never eat lunch served at school, or only eat it 1-2 times a week, why?

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* 13. When you decide whether or not to get lunch at school, how important are each of the following to your decision?

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* 14. What would encourage you to participate in lunch more often?

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* 15. Now for the same list rate how well your school cafeteria does for each.

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* 16. What is your overall satisfaction level with each of these items served in your school cafeteria?

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* 17. What is your favorite lunch item?

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* 18. What is your favorite vegetable? (Check all that apply)

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* 19. What is your favorite fruit? (Check all that apply)

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* 20. When you decide to whether or not to get breakfast or lunch at school, how important are each of thefollowing to your decision?

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* 21. Tell us how much you agree or disagree with the statements about school breakfast or lunch this year.

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* 22. Now for the same list rate how well your school cafeteria does for each.

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* 23. Using stars from 1 to 10, where 1 is the worst school cafeteria possible and 10 is the best schoolcafeteria possible, how many stars would you give your school cafeteria?

* 20. When you decide to whether or not to get breakfast or lunch at school, how important are each of the
following to your decision?

* 23. Using stars from 1 to 10, where 1 is the worst school cafeteria possible and 10 is the best school
cafeteria possible, how many stars would you give your school cafeteria?