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Food Survey
The survey that follows is being used to gain information about individuals eating patterns and habits. All results will be taken into consideration to make a diet plan for college students.
 
Quiz
Name:
Phone Number:
Address:
 
Date of Birth:
Gender:  Male   Female
College Education:
I make food at home rather than go out to eat. Strongly Disagree  Disagree  Neither  Agree  Strongly Agree
I feel that I am a healthy eater.  Strongly Disagree  Disagree  Neither  Agree   Strongly Agree
I know how to cook. Strongly Disagree  Disagree  Neither  Agree  Strongly Agree
Breakfast can be eaten for lunch. Strongly Disagree  Disagree  Neither   Agree   Strongly Agree
My diet follows the food pyramid. Strongly Disagree  Disagree  Neither  Agree  Strongly Agree
My favorite meal of the day is: Breakfast  Lunch  Dinner  Late-Night
My favorite ethnic food is:
Mexican Lebanese Thai
Chinese Italian Greek
Any food allergies?   Yes  No
What food do you not like?
Comments/Suggestions?
Thank You
Your input is much appreciated. We're going to work now to find a solid diet.  
j5kamysiak@wmich.edu Copyright