Grade Level
How do you get to
school? (circle)
What is your favorite…?
Food .................................................................................
Drive myself
Candy ................................................................................
Ride the bus
Drink..................................................................................
Get dropped off
Snack .................................................................................
Do you normally eat breakfast before school?
(circle) Yes No
What’s the normal menu?
Do you arrive late or
leave early as part of
your schedule? (circle)
Early Late
No Both
What do you usually do for lunch? (circle)
Buy@Cafeteria
Bring Own
Leave
None
Who do you live with?
If you aren’t the only child, tell me about
your brothers and sisters.