* 1. What is your age?

* 2. Are you male or female?

* 3. What is your race? Please choose one or more.

* 4. What college/university do you attend?

* 5. What is your major?

* 6. Please select your following status:

  Full-Time Part-Time N/A
Student
Employed

* 7. Please answer the following:

  Yes No
Do you receive financial aid?
Are you currently employed?

* 8. How do you commute to school?

* 9. Please answer the following:

  Yes No Don't know
Do you have any dietary restrictions?
Do you shop for your own food?
Does the price of food affect what you buy?
Do you take nutritional supplements?

* 10. Please answer the following:

  Yes No Don't know
Does your campus offer chain restaurant locations?
Do any of these restaurants offer made-to-order options?
Do the vending machines have a label for healthy choices?
Does the school provide you with a way to reheat food?
Do you know where the microwaves are on campus?

* 11. Are you satisfied with the quality of food on campus?

* 12. On a typical day, how often do you consume any of the options below?

  0 1 2 3 4 5+
Fruit
Meat
Candy
Eggs
Coffee Drinks
Energy Bars
Vegetables
Bread
Potato chips
Chicken
Fish
Nuts
Soda
Electrolyte Drinks

* 13. During the week, how often do you:

  0 1 2 3 4 5 6 7 7+
Eat at a restaurant?
Have a workout lasting more than 30 minutes?
Bring food prepared from home to school or work?
Eat microwaveable or ready-made meals?
Skip a meal?
Replace a meal with vending machine options?
Buy food and snacks on campus?
Plan out your meals?

* 14. Please answer the following:

  Yes No Don't know
Do you eat from restaurants on campus?
Do you find the food offered on campus to be healthy?
If the calories are listed on the menus, does that influence your food purchases?

* 15. Do these phrases affect your eating habits?

  Yes No Does not affect
Healthy
Organic
Low Sodium
All-Natural
No/Low Sugar
No Fat
Gluten-Free
Vegan

* 16. Please select the three items of "empty calories" from the choices below.

* 17. Please distinguish between "good" and "bad" fats.

  Good Bad Don't know
Monounsaturated
Saturated
Unsaturated
Trans

* 18. Which of the following is the preferred energy source for the body?

* 19. How concerned are you about eating healthy?

* 20. In general, how would you rate your overall health?

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