Kilicao High School
SENIOR HIGH SCHOOL
Kilicao, Daraga, Albay
Eating Habits and Academic Performance of Kilicao High School Grade 12 Students:
A Correlational Analysis
I. Socio-Demographic Profile
Name: (Optional)____________________________________Grade Level:________________
Address:______________________ Age:____Gender:_____ Daily Allowance:______________
II. Personal Dietary Assessment
For each food listed, check which indicator best describes your food consumption in a week
Breakfast
Food Daily Thrice a Twice a Once a Not at
Week Week Week all
A. Dairy Foods
1. Skim or low fat milk (8 oz. glass)
2. Whole milk (8 oz. glass)
3. Yugort (1 cup)
4. Ice cream (1/2 cup)
5. Cheese (1/2 cup)
6. Margarine added to food or bread
7. Butter added to food or bread
B. Fruits
1. Fresh apple or pears
2. Orange
3. Fresh fruit juice (any kind)
4. Banana
5. Canned fruits (any kind)
C. Vegetables
1. Tomatoes
2. String beans
3. Carrots
4. Corn
5. Squash
6. Green Leafy Vegetables
D. Proteins
1. Eggs
2. Chicken
3. Liver
4. Beef
5. Pork
6. Fish
E. Carbohydrates
1. Rice
2. Bread
3. Root crops
1. Tea
2. Coffee
3. Beer
4. Wine
5. Liquor
6. Softdrinks