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Dear Resident: The purpose of this survey is to gather information about a potential mobile food market in your area. Your answers will help us determine how a mobile food market will best serve your community. All responses will be kept confidential.

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1. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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2. Are you male or female?

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3. Please mark which age range that you would best fit in.

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4. How many people are currently living in your household (including yourself)?

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5. How many people under 18 live in your household (including any unborn children)?

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6. Does anyone in your household who may potentially shop at the mobile market use any of the following:

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7. Who does most of the grocery shopping in your house?

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8. How much, on average, do you usually spend on fruits and vegetables per week?

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9. If a mobile market were coming to your community, what are the top five FRUITS or VEGETABLES you would like for it to carry? (Please be as specific as possible)

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10. If a mobile market were coming to your community, what are the top five STAPLE foods you would like for it to carry? (ex: beans,rice, sugar, flour, milk, cheese, eggs, etc.)

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11. What is currently your main source of transportation?

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12. What are two locations in your community that would make a mobile food market most convenient for you (Please be specific)? (ex: Westside Baptist Church, Calvin Donaldson Elementary, Avondale Recreation Center)

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13. Which day(s) of the week would make a mobile market more accessible to you and your community?

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14. Which time(s) of the day would make a mobile market more accessible to you and your community?

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15. Which time(s) of the month would make a mobile market more accessible to you and your community?

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