What is your present weight _______________
What is your present height ________________
1)	How old are you?
	a)	Under 18
	b)	18–19
	c)	20–21
	d)	22
	e)	Over 22
2)	What is your gender?
	a)	Male
	b)	Female
3)	What academic year are you in?
	a)	Freshmen
	b)	Sophomore
	c)	Junior
	d)	Senior
4)	What is your major?
	a)	STEM (Science, Math)
	b)	Health Science (Nursing, Kinesiology)
	c)	Professional program (Business, Education, Sports Management)
	d)	Liberal Arts (English, Psychology, History, Philosophy and Religion, Music, Legal Studies, Political Science, Media Arts, American Studies)
	e)	Other (non-degree student)
5)	Are you a member of an on campus athletic team?
	a)	Yes
	b)	No
6)	Where do you live while attending College?
	a)	On campus
	b)	Off campus
	c)	At home with parents
7)	During the week (Monday through Friday) where do you usually eat?
	a)	Dining hall
	b)	Wolverine Stop
	c)	Fast food restaurant such as (McDonald’s, Wendy’s, Pizza hut, etc.)
	d)	Parents house
	e)	Other ____________
8)	During the weekend (Saturday and Sunday) where do you usually eat?
	a)	Dining hall
	b)	Wolverine Stop
	c)	Fast food restaurant such as (McDonald’s, Wendy’s, Pizza hut, etc.)
	d)	Parents house
	e)	Other ____________
9)	What is the most typical snack that you consume?
	a)	Fresh fruit
	b)	Yogurt
	c)	Potato chips (or similar fried food)
	d)	Chocolate or Candy bar
	e)	Energy bar
10)	What kind of bread do you eat most often?
	a)	100% whole wheat
	b)	Whole grain
	c)	White, "wheat", Italian, or French
	d)	Croissant or biscuit
	e)	I do not eat bread
11)	How much fruit do you eat on a daily basis?
	a)	More than 3 cups
	b)	3 cups
	c)	2 cups
	d)	1 cup
	e)	0 cups
12)	What quantity of vegetables do you eat on a daily basis?
	a)	More than 3 cups
	b)	3 cups
	c)	2 cups
	d)	1 cup
	e)	0 cups
13)	How much milk, cheese, and/or yogurt do you consume on a daily basis?
	a)	More than 3 cups
	b)	3 cups
	c)	2 cup
	d)	1 cup
	e)	0 cups
14)	How many ounces of protein (meat, beans, eggs, nuts, etc.) do you eat on a daily basis? (Hint: 3 ounces of meat, cooked, is approximately the size of a deck of cards)
	a)	More than 6 oz
	b)	6 oz
	c)	5 oz
	d)	4 oz
	e)	3 oz
	f)	Less than 3 oz
15)	When you are eating out, do you select your meal choice primarily because of…
	a)	Taste
	b)	Attempts to make healthier choices
	c)	Allergy issues
	d)	Cost
	e)	Convenience
16)	What kind of meat do you eat on a regular basis (more than 4 times per week)?
	a)	beef
	b)	pork
	c)	chicken
	d)	fish
	e)	processed meat (salami, ham, cold-cuts, hot-dogs, etc.)
	f)	do not eat meat
17)	Since entering College, has your weight
	a)	Increased
	b)	Decreased
	c)	Stayed the same
18)	Do you take supplements?
	a)	Multivitamins
	b)	Health supplements (fish oil, calcium, etc.)
	c)	Sport supplements
	d)	Herbal supplements
	e)	Energy drinks
	f)	I do not take any supplements
19)	Do you eat breakfast?
	a)	Daily
	b)	3 or 4 times a week
	c)	Once or twice per week
	d)	Rarely
20)	How many legitimate meals do you have each day?
	a)	One
	b)	Two
	c)	Three
	d)	More than three
21)	How often do you exercise for more than 30 minutes at a time?
	a)	0–2 times per week
	b)	3–4 times per week
	c)	More than 5 times per week
22)	Does nutritional information on food labeling in the grocery store, influence your purchases?
	a)	Yes
	b)	No
23)	Did you get a flu-shot during the past year?
	a)	Yes
	b)	No
24)	Do you add salt to your food at the table?
	a)	yes
	b)	no
25)	Have you tried a diet-plan during the past year?
	a)	yes
	b)	no