What Do You Know About 5-2-1-0?

Quick 5-2-1-0 Awareness Survey

Jump IN for Healthy Kids is launching a campaign to raise awareness about 5-2-1-0 Healthy Habits. We want to know if you're familiar with the concept before the campaign. Individual demographic information will be kept confidential and not shared with any other individual or organization.

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* 1. Full Name

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* 2. Email address. Sharing your email address enters you in a drawing for a $100 Amazon gift card! We do not share or sell email addresses or any other personal information.

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* 3. What is your ethnicity?

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* 4. What is your race? Mark one or more races to indicate what you consider yourself to be.

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

White

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* 5. Have you ever heard of 5-2-1-0?

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* 6. Zip Code

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* 7. Annual Household Income

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000