Survey

**Survey**
 * __Eating Habits __**

Male Female On-campus Off-campus (without your parents/guardians) Off-campus (with your parents/guardians) 1-5 6-10  11-15  15+  Yes (Part time) Yes (Full time) No Breakfast (at home, home cooked meal, at UTM food courts, off-campus) Lunch (at home, home cooked meal, at UTM food courts, off-campus) Dinner (at home, home cooked meal, at UTM food courts, off-campus) Snack (at home, home cooked meal, at UTM food courts, off-campus) Yes No
 * 1. Please state your gender.**
 * 2. How old are you? **
 * 3. Where do you live? **
 * 4. How many hours of class do you have per week? **
 * 5. Do you work during the school year (Sept. to April)? **
 * 6. Where do you eat for each of the following meals? **
 * 7. Do you cook? **

Your parents cook Busy Schedule Don’t know how to cook Hate cooking Other_____________
 * 8. IF NO why don’t you cook? **

____
 * 9. IF YES what do you cook and how often per day?**

$0 $1-$30 $31-$60 $61-$90 $91+
 * 10. How much money do you spend weekly on buying groceries?**

0 1-2 3-4 5-6 7+
 * 11. How often do you eat outside food (not including things you cook) in a week?**

$0 $1-$20 $21-$40 $41-60 $60+
 * 12. How much money do you spend weekly on buying meals? (not including groceries)**

0 1-2 3-4 5-6 7+
 * 13. How often do you eat junk food per week?**

Grain Products (0-2, 3-5, 6-8, 9-11, 12-14) Vegetables and Fruits (0-2, 3-5, 6-8, 9-11, 12-14) Milk Products (0-2, 3-5, 6-8, 9-11, 12-14) Meats and Alternatives (0-2, 3-5, 6-8, 9-11, 12-14)
 * 14. How many servings do you have per day of the following four food groups?**


 * 15. If you do have any health problems please list them below.**

Yes No
 * 16. Do you use the gym facility provided at UTM or any other fitness centre?**

No time Lack of motivation Don’t like going to the gym Other_______________
 * 17. IF NO, why?**

1-2 3-4 5-6 More than 6
 * 18. IF YES how often do you go per week?**


 * 19. Please state any other physical activities you participate in (ex. Yoga, dance, sports, etc.).**