SURVEY QUESTIONNAIRE

TITLE: INFLUENCE OF PARENTS ON THE EATING HABITS OF

STUDENTS: BASIS FOR IMPROVEMENT OF NUTRITIONAL
STATUS

FINAL BMI________________________Nutritional status ______________

NAME: (Optional)____________________

I. Directions: Tick the mealtimes you eat

5 - Always
4 - Often
3 - Sometimes
2 - Seldom
1 - Never
Mealtimes Always Often Sometimes Seldom Never
Breakfast
Morning Snack
Lunch
Afternoon snack
Dinner

II. Directions: Tick the column of your choice.

5 - Always
4 - Often
3 - Sometimes
2 - Seldom
1 - Never
Sometimes

Seldom
Always

Never

Food Preference
Often

I prefer to eat...
Go
1. Whole cereal grain such as rice,
corn, and oath meal etc.
2. Bread products such as pandesal,
tasty and monay etc.

1
 3. Dairy products such as milk, cheese,
and yogurt etc.
4. Root crops such as sweet potato,
cassava and taro etc.
Grow
5. Meat products such as pork, beef,
and carabeef etc.
6. Poultry products like, chicken, duck,
etc.
7. Fish product like tilapia, bangus and
galunggong etc.

8. Seafood products like shrimp,

clamps and squid etc.
Glow
9. Leafy vegetable like kangkong,
pechay, mustasa etc.
10. Fruits like banana, papaya, and
apple. and Pine apple etc.
11. Vine crops such as ampalaya,
patani, upo, and patola etc.