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Teen Teacher Survey (Retrospective) - FY17

 

Please fill out as completely as possible.

Section I: Nutrition Knowledge

1. Please indicate to what extent you agree or disagree that your experience in the UC CalFresh Program (Program) has resulted in the following outcomes. (Select one response in each row by marking the appropriate box.)

                   
                   
                   
                   

Section II: Food Choices

2. Please indicate to what extent you agree or disagree that your experience in this Program has resulted in the following outcomes. (Select one response in each row by marking the appropriate box.)

                   
                   
                   
                   

3. Please indicate to what extent you agree or disagree that your experience in this Program has resulted in the following outcomes. (Select one response in each row by marking the appropriate box.)

                   
                   
                   
                   
                   

4. Because of participating in this Program...(Select one response in each row by marking the appropriate box.)

                   
                   
                   
                   
                   
                   
                   
                   
                   

Section III: Physical Activity

Section IV: Engagement and Understanding

8. Please indicate to what extent you agree or disagree that your experience in this Program has resulted in the following outcomes. (Select one response in each row by marking the appropriate box.)

               
               
               
               
               
               
               

9. Please indicate how likely you are to complete the following outcomes. (Select one response in each row by marking the appropriate box.)

               
               
               

10. For each of the following statements, rate your ability to perform each skill. In the left-hand columns indicate your ability BEFORE the Program. In the right-hand columns, indicate your ability NOW. (Select one response in each row by marking the appropriate box.)

               
               
               
               
               
               
               
               
               
               
               
               

11. Please rate your level of agreement with each of the following statements related to your experience as teen teacher in this program. (Select one response in each row by marking the appropriate box.)

               
               
               
               
               
               
               
               
               

12. Please rate how you felt BEFORE the Program and then AFTER the Program. (Select one response in each row by marking the appropriate box.)

                   
                   

Section VI: Tell us about you

Section VII: Tell us about your UC CalFresh Program (or other locally used name) experience.