Food For All For A Healthier Community Survey Question Title * 1. In what zip code do you live and/or work? 60401 60403 60404 60407 60408 60410 60416 60417 60421 60423 60431 60432 60433 60434 60435 60436 60439 60440 60441 60442 60443 60446 60447 60448 60449 60451 60466 60467 60468 60471 60475 60477 60481 60482 60484 60487 60490 60491 60503 60517 60543 60544 60564 60565 60585 60586 Question Title * 2. What is your current family size? (including yourself) 1-3 individuals 4-6 individuals 6+ individuals Question Title * 3. How many individuals in your home are under 18 years old? 0 1-2 3-4 5+ Question Title * 4. Where do you currently shop for food? select all that apply Family dollar Gas station Convenient store Food For Less Wal-Mart Jewel/Osco Berkots Meijer Sams Club Farmers Market Aldi Supermercado Joliet Jalisco Mexican Store Supermercado las Palmas Supermercado la Loma El Ranchito Other (please specify) Question Title * 5. How often do you prepare a meal? Never or rarely One to two times per week Three to five times per week Or more than five times per week Other (please specify) Question Title * 6. How often do you/your family eat take-out? Never or rarely One to two times per week Three to five times per week Or more than five times per week Other (please specify) Question Title * 7. How often are you consuming vegetables (Corn, Peas, Carrots, Broccoli, Asparagus, Etc.) Never or rarely One to two times per day Two to three times per day Two to three times per week Once per week Other (please specify) Question Title * 8. How Often are you consuming fruits? (Strawberries, pineapples, blueberries, bananas, apples, oranges, etc.) Never or rarely One to two times per day Two to three times per day Two to three times per week Once per week Other (please specify) Question Title * 9. “I/We worried whether our food would run out before I/we got money to buy more.” Never or rarely Sometimes true Often true Don't know/Refused Question Title * 10. “The food I/we bought just did not last, and I/we did not have money to get more.” Never or rarely Sometimes true Often true Don't know/Refused Other (please specify) Question Title * 11. How often would you shop for fresh produce at a local market in 60433 (Fruits, Vegetables, etc.)? Never or rarely One to two times per week Three to five times per week Or more than five times per week Other (please specify) Question Title * 12. How often would you purchase and consume goods from a local market that are locally grown and produced? Never or rarely One to two times per week Three to five times per week Or more than five times per week Don't know/Refused Question Title * 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. Fruits Vegetables Dairy Meats Other (please specify) Question Title * 14. Are you or someone in your household a SNAP (Supplemental Nutrition Assistance Program) recipient? Yes No Other (please specify) Question Title * 15. Are you or someone in your household a WIC (Women Infant Children Program) recipient? Yes No Other (please specify) Question Title * 16. Would you be interested in learning more about locally grown produce and business opportunities for residents? Yes No Other (please specify) Question Title * 17. If yes, select all that apply Agriculture/Horticulture Services Personal gardening Building a Community Garden Obtaining food service education and licensure Managing a local Fresh Market Other (please specify) Question Title * 18. Would you like to see more community gardens locally available for community use? Yes No Other (please specify) Question Title * 19. How often do you read the label on food products before you purchase or consume them? Never or rarely Sometimes Often Don't know/Refused Question Title * 20. How familiar are you with finding the serving size on the food product/nutrition label? Not at all Somewhat familiar Familiar Very familiar Question Title * 21. How familiar are you with finding the sodium (salt), fat, and sugar content on the food/nutrition label? Not at all Somewhat familiar Familiar Very familiar Question Title * 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) Not at all Somewhat familiar Familiar Very familiar Question Title * 23. Would you be interested in learning more about nutritional or dietary guidelines? Yes No If yes, what delivery method would you use? (In-person, online, a combination of in-person and online) Question Title * 24. Where do you currently get information for food recipes or learn about the foods you make and consume? (select all that apply) Family/friends Internet TV Books Medical/Health providers Community program Personal trainer/coach Other (please specify) Question Title * 25. In your opinion, do you feel you have access to healthy food options in 60433? Yes No Please describe if chosen yes or no Question Title * 26. Would you be willing to share your "go to meal" "go to recipe" ? if yes, describe to us! Yes No If yes please describe Question Title * 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) Question Title * 28. Would you also be willing to share your favorite healthy recipe with us? Question Title * 29. We would like to learn a little more about your background. Question Title * 30. What is your current employment status? Unemployed (not currently looking for work) Unemployed, currently looking for work Unable to work Student Retired Self-employed Employed part-time (less than 40 hours a week) Employed full-time (40+ hours a week) Question Title * 31. Are you of Latino, Hispanic, or Spanish origin? Yes No If yes, please describe Question Title * 32. What racial background would best describe you? African American/Black Asian Asian Indian Native American/Indigenous Pacific Islander White Mixed Other Please describe Question Title * 33. What is your household income? Below $10,000 $10,000 to $50,000 $50,000 to $100,000 $100,000 to $150,000 Over $150,000 Question Title * 34. What is the highest degree or level of school you have completed? Less than a high school diploma High school degree or equivalent Some college Bachelor's degree Master's degree Doctorate Other (please specify) Question Title * 35. Which gender do you identify with? Female Male Don't know/Refuse Other (please specify) Question Title * 36. Do you have any serious disability or impairment that makes shopping or preparing food difficult? Yes No Don't know/Refused Question Title * 37. Does anyone in your household have access to personal transportation? Yes No Other (please specify) Question Title * 38. Would you say your health in general is... Poor Fair Good Excellent Question Title * 39. What is your present religion, if any? Done