INTRODUCTION

The questions on this survey ask about foods you eat, your physical activity, and what you know about how to be healthy. THIS IS NOT A TEST.

Your answers will be private. There is a space for your name below, but your name will be removed from this paper and a code number added before anyone looks at your answers. The list of names and code numbers will be kept private and will be deleted when all information is collected. If reports are written about 5th Gear Kids, we will talk about the results from these surveys as a whole group only, so no one will know what you said.

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* 1. First Name

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* 2. Last Name

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* 3. Name of your school

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* 4. Did you participate in the 5th Gear Kids program?

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