Tell us how to get in touch with you:

Parent's Name
Student's Name
E-mail
Telephone

Please check what type of student your child is:

Returning New

1.  Do you have any concerns about your child's eating habits?

Yes    No

If yes, please be specific:

 

2.    Does the dining service offer enough variety to satisfy your child's tastes?

Yes    No

If no, what foods need to be added?

 

3.    Are our hours of operation adequate for serving your child?

Yes    No

If no, what hours of operation would you suggest for meeting your child's schedule?

 

4.    If you have ever eaten in the dining hall have you been pleased with your overall dining experience?

Yes    No

If no, where can we improve?

5.     What was a typical day's menus for your child before coming to Culver?

Breakfast	Lunch	Supper
Skipped	Skipped	Skipped
Fast food breakfast sandwich	Packed lunch from home	Fast food sandwich & fries
Cereal & Milk	School Lunch	Meat, starch, vegetable and salad prepared and eaten at home
Sweet roll or donut	Fast Food	Meal at full service restaurant
Other (if other please specify below)	Other (if other please specify below)	Other (if other please specify below)

6.    What is your child's favorite food or recipe?  Please type the recipe in the box below:

7.     Please type any additional questions or comments in the space provided below: