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* 1. In what zip code do you live and/or work?

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* 2. What is your current family size? (including yourself)

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* 3. How many individuals in your home are under 18 years old?

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* 4. Where do you currently shop for food? select all that apply

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* 5. How often do you prepare a meal?

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* 6. How often do you/your family eat take-out?

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* 7. How often are you consuming vegetables (Corn, Peas, Carrots, Broccoli, Asparagus, Etc.)

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* 8. How Often are you consuming fruits? (Strawberries, pineapples, blueberries, bananas, apples, oranges, etc.)

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* 9. “I/We worried whether our food would run out before I/we got money to buy more.”

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* 10. “The food I/we bought just did not last, and I/we did not have money to get more.”

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* 11. How often would you shop for fresh produce at a local market in 60433 (Fruits, Vegetables, etc.)?

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* 12. How often would you purchase and consume goods from a local market that are locally grown and produced?

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* 13. What types of produce (fruits, grains, vegetables) and goods (meats, dairy, soap, other products) would you like seen sold at the local market? Select all that apply.

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* 14. Are you or someone in your household a SNAP (Supplemental Nutrition Assistance Program) recipient?

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* 15. Are you or someone in your household a WIC (Women Infant Children Program) recipient?

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* 16. Would you be interested in learning more about locally grown produce and business opportunities for residents?

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* 17. If yes, select all that apply

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* 18. Would you like to see more community gardens locally available for community use? 

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* 19. How often do you read the label on food products before you purchase or consume them?

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* 20. How familiar are you with finding the serving size on the food product/nutrition label?

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* 21. How familiar are you with finding the sodium (salt), fat, and sugar content on the food/nutrition label?

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* 22. How familiar are you with dietary guidelines that provide insight on the amount and types of foods to consume daily? (American Heart Association heart healthy guidelines)

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* 23. Would you be interested in learning more about nutritional or dietary guidelines?

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* 24. Where do you currently get information for food recipes or learn about the foods you make and consume? (select all that apply)

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* 25. In your opinion, do you feel you have access to healthy food options in 60433?

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* 26. Would you be willing to share your "go to meal" "go to recipe" ? if yes, describe to us!

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* 27. To be featured anonymously in our new "Neighborhood Cookbook", would you be willing to share your favorite recipe with us?..(important to make sure participants know recipes may be adjusted)

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* 28. Would you also be willing to share your favorite healthy recipe with us?

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* 29. We would like to learn a little more about your background.

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* 30. What is your current employment status?

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* 31. Are you of Latino, Hispanic, or Spanish origin?

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* 32. What racial background would best describe you?

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* 33. What is your household income?

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* 34. What is the highest degree or level of school you have completed?

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* 35. Which gender do you identify with?

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* 36. Do you have any serious disability or impairment that makes shopping or preparing food difficult?

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* 37. Does anyone in your household have access to personal transportation?

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* 38. Would you say your health in general is...

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* 39. What is your present religion, if any?

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