Community Conversation on Local Food Access

Chickasaw County

Tuesday, October 27th

11:00am-12:30pm

Iowa State University Extension Office

115 N Broadway Ave, New Hampton Iowa

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1. Name (Required.)

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2. Email

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3. Phone

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4. Address

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5. Please list the organization(s), agency (agencies) or business(es) you represent. If none, leave blank.

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6. How did you hear about the Community Conversation on Food Access and Local Solutions? (Required.)

Local food pantry

Community Agency

Invitation from Northeast Iowa Food Bank

Other (please specify)

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7. Please indicate which of the following applies to you? Check all that apply. (Required.)

I am a client at the local food pantry

I am a client at a local Community Agency (non-food services)

I am a volunteer/staff at a food pantry

I am a volunteer/staff at a Community Agency(non-food services)

I am a local school representative

I am a local city/community representative

Other (please specify)

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8. Will you need to arrange childcare so you can attend this forum? (Required.)

Yes

Community Conversation on Local Food Access

Chickasaw County

Question Title

* 1. Name (Required.)

Question Title

* 2. Email

Question Title

* 3. Phone

Question Title

* 4. Address

Question Title

* 5. Please list the organization(s), agency (agencies) or business(es) you represent. If none, leave blank.

Question Title

* 6. How did you hear about the Community Conversation on Food Access and Local Solutions? (Required.)

Question Title

* 7. Please indicate which of the following applies to you? Check all that apply. (Required.)

Question Title

* 8. Will you need to arrange childcare so you can attend this forum? (Required.)

1. Name (Required.)

2. Email

3. Phone

4. Address

5. Please list the organization(s), agency (agencies) or business(es) you represent. If none, leave blank.

6. How did you hear about the Community Conversation on Food Access and Local Solutions? (Required.)

7. Please indicate which of the following applies to you? Check all that apply. (Required.)

8. Will you need to arrange childcare so you can attend this forum? (Required.)