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Questionnaire:

Questionnaire:

Name:_____________________________

Name:_____________________________

Age:_________ Sex: ________________

Age:_________ Sex: ________________

Household Income: __________________

Household Income: __________________

Consumption in a day:_________________

Consumption in a day:_________________

Number of ppl in household:____________

Number of ppl in household:____________

Height:_____________________________

Height:_____________________________

Weight:_____________________________

Weight:_____________________________

Grade Status:________________________

Grade Status:________________________

Notes:______________________________

Notes:______________________________

___________________________________

___________________________________

Questionnaire:

Questionnaire:

Name:_____________________________

Name:_____________________________

Age:_________ Sex: ________________

Age:_________ Sex: ________________

Household Income: __________________

Household Income: __________________

Consumption in a day:_________________

Consumption in a day:_________________

Number of ppl in household:____________

Number of ppl in household:____________

Height:_____________________________

Height:_____________________________

Weight:_____________________________

Weight:_____________________________

Grade Status:________________________

Grade Status:________________________

Notes:______________________________

Notes:______________________________

___________________________________

___________________________________

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