Age:
Gender:
Class:
How many times per week do you eat fast food?
Cook meals?
How many energy drinks do you consume per week?
Soda?
Coffee?
Water?
How many hours of sleep do you get in an average week?
Do you drink alcohol?
If so, how many times per week?
Do you smoke cigarettes?
How many per day?
Do you hold a job?
If so, how many hours per week?
How many hours do you spend in class per week?
How many hours do you spend on homework?
Do you participate in extracurricular activities?
How many hours per week?
How often do you exercise?
How do you spend your free time, if any?
Hours spent online:
Hours spent watching TV:
Hours spent on the phone:
