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* 1. Type your FIRST NAME

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* 2. Type your LAST NAME

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* 3. School

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* 4. Your Grade Level:

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* 5. During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? (Do not count punch, Kool-Aid, sports drinks, or other fruit-flavored drinks.)

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* 6. During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.)

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* 7. During the past 7 days, how many times did you eat green salad?

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* 8. During the past 7 days, how many times did you eat potatoes? (Do not count french fries, fried potatoes, or potato chips.)

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* 9. During the past 7 days, how many times did you eat carrots?

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* 10. During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)

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