Food Pantry Questionnaire Question Title * 1. Have you ever experienced food insecurity, that is, not knowing where your next meal is coming from, or involuntarily eating less than you need, on a regular basis, for a period of time lasting more than a month? Yes No Question Title * 2. In the past year in your home: (Please check only one.) We have had enough of the kinds of foods we like to eat We have had enough food but not always the kinds of food we like to eat At times we did not have enough to eat We often do not have enough to eat Don’t Know Question Title * 3. Please check all that apply to your food situation over the past year Didn't have enough money for food Someone in my household needs special foods due to a health condition No working stove No working refrigerator Do not know how to make the healthy foods for my family We cannot get to the store because of transportation or other reasons Haven't had any problems getting enough food Other Question Title * 4. Has there been a time when you did not have enough food for yourself or your household? Yes No Question Title * 5. If you answered 'Yes' to the previous question, how often has your food supply been inadequate? 0-1 times per month 2-4 times per month 5-6 times per month 7+ times per month Question Title * 6. How often would you need to access a food pantry? Bi-Weekly Monthly Rarely Not at all Question Title * 7. What day of the week would you want a pantry to be open? (choose one) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Question Title * 8. Which hours of operation would be most convenient for you based on your schedule? 9am-12pm 1-4pm After 5 Question Title * 9. How likely would you come to a food pantry if it was open on a Saturday? Likely Unlikely I wouldn't go on a Saturday Question Title * 10. Rate your agreement with the following statements: Agree Neither Agree or disagree Disagree If I did not have enough food, I would use a food pantry. If I did not have enough food, I would use a food pantry. Agree If I did not have enough food, I would use a food pantry. Neither Agree or disagree If I did not have enough food, I would use a food pantry. Disagree If people you know were in need, do you think they would use a food pantry? If people you know were in need, do you think they would use a food pantry? Agree If people you know were in need, do you think they would use a food pantry? Neither Agree or disagree If people you know were in need, do you think they would use a food pantry? Disagree Is a food pantry is a need in the River Valley Community? Is a food pantry is a need in the River Valley Community? Agree Is a food pantry is a need in the River Valley Community? Neither Agree or disagree Is a food pantry is a need in the River Valley Community? Disagree Question Title * 11. Some pantries offer other items and resources. Here are some items and resources that a pantry might offer. Please indicate if you would like a pantry to have the following item or resources available. Yes No Already available somewhere else Recipes Recipes Yes Recipes No Recipes Already available somewhere else A community meal A community meal Yes A community meal No A community meal Already available somewhere else Nutrition education Nutrition education Yes Nutrition education No Nutrition education Already available somewhere else Clothing Clothing Yes Clothing No Clothing Already available somewhere else Job information Job information Yes Job information No Job information Already available somewhere else Personal Hygiene Items Personal Hygiene Items Yes Personal Hygiene Items No Personal Hygiene Items Already available somewhere else Household items (ex. paper towels, toilet paper) Household items (ex. paper towels, toilet paper) Yes Household items (ex. paper towels, toilet paper) No Household items (ex. paper towels, toilet paper) Already available somewhere else What types of non-food items would you recommend? Are there other items or resources you would like you pantry to offer? Done