Elementary School Survey Question Title * 1. What elementary school do you attend? A) Antonia B) Fox C) Guffey D) Hamrick E) Hodge F) Lone Dell G) Meramec H) Rockport I) Seckman J) Sherwood K) Simpson Question Title * 2. How old are you? A) 7 years old, or younger than 7 B) 8 years old C) 9 years old D) 10 years old E) 11 years old F) 12 years old G) 13 years old, or older than 13 Question Title * 3. Are you male or female? A) Female B) Male Question Title * 4. What grade are you in? A) Kindergarten B) 1st grade C) 2nd grade D) 3rd grade E) 4th grade F) 5th grade G) 6th grade Question Title * 5. Do you eat breakfast every morning? A) No B) Yes Question Title * 6. When you ride in a car, do you wear a seat belt? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 7. When you ride a bicycle, do you wear a helmet? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time E) I do not ride a bicycle Question Title * 8. Are you happy to be at this school? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 9. Do the teachers and other grown-ups at school tell you when you do a good job? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 10. Do the teachers and other grown-ups at school listen when you have something to say? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 11. Do you do things to be helpful at school? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 12. During the past year, how many times have you hit or pushed other kids at school when you were not playing around? A) 0 times B) 1 time C) 2 times D) 3 or more times Question Title * 13. Do other kids hit or push you at school when they are not just playing around? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 14. Do other kids at school spread mean rumors or lies about you on the internet (I.E. Facebook, MySpace, email, instant message)? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 15. Do you feel safe at school? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 16. Do you feel safe outside of school? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 17. Do you try to do your best? A) No, never B) Yes, some of the time C) Yes, most of the time D) Yes, all of the time Question Title * 18. Do you think you are underweight, about right, or overweight? A) Underweight B) About Right C) Overweight Question Title * 19. Have other kids at school ever teased you about what your body looks like? A) No B) Yes Question Title * 20. How many days each week do you exercise, dance, or play sports? A) 0 days B) 1 day C) 2 days D) 3 days E) 4 days F) 5 days G) 6 or 7 days Question Title * 21. Yesterday, how much time did you spend watching TV or playing video games? A) None, I didn't watch TV yesterday B) Less than 1 hour C) About 1 hour D) About 2 hours E) 3 or more hours Question Title * 22. On most school days, do you... take lunch from home eat a school lunch Question Title * 23. On average, how would you rate the lunch from the school cafeteria? Very healthy Healthy Neither healthy or unhealthy Unhealthy Very unhealthy Question Title * 24. How would you improve the school lunch meals? offer more fresh vegetable choices offer more fresh fruit choices offer a better selection of desserts offer new recipes Question Title * 25. Did you understand the questions on this survey? A) No, none of them B) Yes, some of them C) Yes, most of them D) Yes, all of them Done