Summer Breakspot Quick Survey

Please let us know how you learned about Summer BreakSpot to help us ensure we are reaching as many children in need as possible.

Please check all that apply.

* Required Information.

*1.Please enter your zip code.(Required.)

ZIP:

*2.Did you see our TV commercial?(Required.)

Yes

No

*3.How did you hear about our website?(Required.)

1-800 Number

2-1-1 Number

Bus Shelter

Bus Sign

Bus Stop

Business Card/Coupon

Church

DCF/Food Stamp Office/SNAP

Dr.'s Office/Health Fair

Email

Food Bank/Food Pantry

Friend/Relative

Link on Another Website

Newspaper Article

Poster

School

School Flyer

TV Commercial

WIC/Health Department

Other (please specify)

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