Parent Questionnaire

Your Child's School
Please submit a different form for each school if you have more than one child at more than one school.
 

1. Overall, my child likes the school meals provided by the foodservice and nutrition program.
   
Very Satisfied        Satisfied       Dissatisfied

2. My child receives a variety of foods.
    
Very Satisfied        Satisfied       Dissatisfied 

3. My child receives healthful foods.
   
Very Satisfied         Satisfied       Dissatisfied  

4. My child selects nutritious foods.
    
Very Satisfied         Satisfied       Dissatisfied 

5. I know what foods my child eats.
    
Very Satisfied         Satisfied       Dissatisfied 

6. I know how much my child eats.
    
Very Satisfied         Satisfied       Dissatisfied  

7. My child likes the foods provided.
    
Very Satisfied         Satisfied       Dissatisfied  

8. My child has enough time to eat.
    
Very Satisfied         Satisfied       Dissatisfied  

9. My child eats in a pleasant dining area.
    
Very Satisfied         Satisfied       Dissatisfied  

10. My child likes the taste of the food.
    
Very Satisfied         Satisfied       Dissatisfied  

11. I think the cost of the school meals is reasonable for what my child receives.
     
Very Satisfied         Satisfied       Dissatisfied  

12. The foodservice staff are friendly to my child.
     
Very Satisfied         Satisfied       Dissatisfied  

13. My child thinks the foods on the serving line are attractively presented.
    
 Very Satisfied         Satisfied       Dissatisfied  

14. My child thinks the dining area is clean.
    
  Very Satisfied         Satisfied       Dissatisfied  

15. How many times a week does your child eat school breakfast?       

16. How many times a week does your child eat school lunch?      

17. How many times a week does your child bring a lunch from home?  

18. The number one reason my child eats school breakfast is: (Please select only one)

      a) The prices are good.

      b) The food is good.

      c) It is convenient. 

      d) Teachers encourage them to eat.  

      e) I do not prepare breakfast at home.

      f) The meals are nutritious.

      g) Their friends eat school breakfast.

      h) My child does not eat school breakfast.

       i) The school does not have a breakfast program.
 

19. The number one reason my child eats school lunch is:

      a) The prices are good.

      b) It is convenient.

      c) Teachers encourage them to eat.

      d) I feel school lunch is better for my child than a brown bag lunch.

      e) Their friends eat school lunch.

      f) The meals are nutritious.

      g) My child does not eat school lunch.

"In accordance with Federal law and U.S. Department of Agriculture Policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability.  To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Bldg, 1400 Independence Ave., S.W., Washington, DC 20250-9410 or call (202)720-5964 (Voice & TDD).  "USDA is an equal opportunity provider & employer." 

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