SurveyMonkey Powered Online Survey

3SquaresVT Challenge Registration

Thank you for your interest in taking the 3SquaresVT Challenge and being willing to eat on a limited food budget for a week, day, or meal. Please fill out this short registration form.

Question Title

1. Name

Question Title

2. Organization (if any)

Question Title

3. Town where you live

Question Title

4. Email address (where you'd like to receive updates and important information about the Challenge)

Question Title

5. Are you taking the challenge for a week, a day, or a meal?

Week

Day

Meal

Question Title

6. How many people in your household will be taking the Challenge?

Other (please specify)

Question Title

7. Tell us why you’re doing the Challenge or what you hope to learn:

Question Title

8. How did you hear about the 3SquaresVT Challenge?

Email invitation

Facebook invitation

Hunger Free Vermont Website

Teacher/Class

Media (newspaper, radio, tv)

Word of Mouth

Other (please specify)

Question Title

9. How will you share your experience of doing the Challenge with others?

Post on Challenge Facebook Page

Submit a Letter to the Editor

Talk about it with friends, family, classmates or colleagues

Email VT Lawmakers about the importance of the program

All of the above

Other (please specify)

Question Title

10. Local reporters sometimes like to interview Challenge participants in various regions of Vermont. Would you be willing to be contacted for a telephone or in person interview? Hunger Free VT would check with you first before connecting a reporter with you.

Question Title

1. Name

Question Title

2. Organization (if any)

Question Title

3. Town where you live

Question Title

4. Email address (where you'd like to receive updates and important information about the Challenge)

Question Title

5. Are you taking the challenge for a week, a day, or a meal?

Question Title

6. How many people in your household will be taking the Challenge?

Question Title

7. Tell us why you’re doing the Challenge or what you hope to learn:

Question Title

8. How did you hear about the 3SquaresVT Challenge?

Question Title

9. How will you share your experience of doing the Challenge with others?

Question Title

10. Local reporters sometimes like to interview Challenge participants in various regions of Vermont. Would you be willing to be contacted for a telephone or in person interview? Hunger Free VT would check with you first before connecting a reporter with you.

Question Title

11. Comments/Questions?