* 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.