Questionnaire for School Form

Questionnaire for Conducting a Health Session in School

General Information

School Name *

Address *

Contact Person *

Contact Email *

Contact Phone Number *

Student Demographics

Total Number of Students *

Grade Levels *

Age Range of Students*

Are there any specific dietary restrictions or allergies common among students? (e.g., nut allergies, gluten intolerance, lactose intolerance) *

Are there any cultural or religious dietary practices that should be considered?

Health and Nutrition Concerns

What are the main health and nutrition concerns you would like to address? (e.g., obesity, undernutrition, eating disorders, general nutrition education)

Have there been any recent health trends or issues observed among students?

Are there any specific nutritional deficiencies that are common among the student population?

Current Nutrition Education

Does the school currently have a nutrition education program? If yes, please provide details.

How frequently are nutrition and health topics covered in the curriculum?

Who currently provides nutrition education at your school? (e.g., teachers, external experts, school nurse)

Do you have any existing partnerships with health organizations or nutritionists?

Session Logistics

Preferred Dates and Times for the Health Session

Duration of the Session

Preferred Format of the Session: (e.g., lecture, interactive workshop, Q&A session)

Do you have any specific topics you would like the session to cover? (e.g., balanced diet, healthy snacking, importance of hydration)

Will any equipment or materials be provided by the school? (e.g., projector, computer, handouts)

What type of space will be available for the session? (e.g., classroom, auditorium, gymnasium)

Engagement and Follow-Up

Would you like the session to include interactive elements? (e.g., hands-on activities, cooking demonstrations)

How would you like to assess the effectiveness of the session? (e.g., surveys, feedback forms, follow-up sessions)

Are there any specific goals or outcomes you hope to achieve from the health session?

Would you be interested in ongoing nutrition education or follow-up sessions?

Additional Information

Is there any additional information or special considerations that we should be aware of?

Thank you for providing this information. It will help us tailor the health session to meet the needs of your students and ensure a successful and informative event. Please feel free to contact us with any further questions or details.

I agree to all above mentioned conditions.