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Name (Optional):
   
Age:
   
Student No.:
   
Year Level:
   
Body Weight:
   
Daily Food Budget:
   
Actual Cost of Food (Daily):
   
 
 
 
Source of Protein (Check as many as possible):
 
beans
 
nuts
 
peas
 
pork
 
beef
 
chicken
 
fish and other seafoods
 
milk
 
cheese
 
egg
 
tofu

 
 
 
How often do you eat these foods?
 
everyday
 
once a week
 
twice a week
 
thrice a week
 
once in a month
 
Other
 
 
 
 
How many times in a day do you eat? (excluding snacks)
 
once
 
twice
 
thrice
 
 
 
If not 3 times a day, Why? (check as many as you can)
 
busy
 
on a diet
 
out of budget
 
Other
 

 
 
 
Among the mentioned sources of protein, which do you prefer the most?
 
beans
 
nuts
 
peas
 
pork
 
beef
 
chicken
 
fish and other seafoods
 
milk
 
cheese
 
egg
 
tofu
 
 
 
Where do you eat most of the time?
 
school canteen
 
eateries near boarding house
 
packed foods (baon)
 
home
 
restaurants
 
Other
 
 
 
 
Are the sources of protein mentioned available from where you eat?
 
Yes
 
No
 
Other
 
 
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