Please fill out completely as much as possible.
AGENCY NAME: ✻
DATE:
Which curriculum did you use with this family?
Please indicate your level of agreement with the following statement:
As a result of this curriculum, this child is able to Make the connection between healthy foods and a healthy body... ✻
As a result of this curriculum, this child is able to Identify two or more foods that give them energy ✻
As a result of this curriculum, this child is able to Identify two or more vegetables ✻
As a result of this curriculum, this child is able to Identify two or more foods from the milk group ✻
As a result of this curriculum, this child is able to Name three ways to be active ✻
As a result of this curriculum, this child is able to Understand the importance of hand washing ✻
As a result of this curriculum, this child is able to Recognize that exercise keeps them healthy and strong ✻
Please describe any significant health behavior changes you as the educator have observed
