* 1. Please rate your overall satisfaction in the Food for Kids Backpack Program.

* 2. How has the program affected your family?

* 3. Has the program helped your household save money?

* 4. Has the program made a positive difference in the well being of your child?

* 5. Please write in your words how the Food for Kids Backpack Program has affected you and your family.

* 6. Any other comments, concerns, ideas, etc..?

* 7. How can we reach you if you are selected for the $25 grocery gift card? Please include your name, phone number, and/or mailing address.