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* 1. Enter your contact information

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* 2. Are you Indigenous?

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* 3. Do you live off reserve?

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* 4. Do you currently rent or own your home?

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* 5. What is your age?

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* 6. What is your gender identity?

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* 7. Which Friendship Centre programs have you attended in the past year?

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* 8. Are you experiencing challenges with regular bill payments? For example, rent, hydro, other utilities etc.

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* 9. Are you experiencing food insecurity? For example, economic challenges that regularly limit your grocery and produce shopping options.

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* 10. Do you feel your food security has changed over the last year? For example, struggling to find affordable meal options.

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* 11. Do you feel you would benefit from participation in the Dze L K'ant FC  weekly community lunch program?

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* 12. Will you complete required feedback forms - online, by phone, or on paper? NOTE: You can ask a staff member to assist you to do this.

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* 13. Do you give consent for Dze L K'ant Friendship Centre to use non-identifying information about you to report to our funders? NOTE: Non-identifying means your name is not used and the information will remain anonymous.

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* 14. Within our limited resources, Dze L K'ant Friendship Centre strives to meet the needs of community members most in need.

"I understand that this program has a limited number of spaces and will run from August until December 2022."

Please check the box to show you understand.

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* 15. "I understand that not all applicants will be admitted to the program and that  selection will be based on economic hardship."

Please check the box to show you understand.

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