FFVRx October 2020

Demographics

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your zip code?

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* 4. What is your phone number?

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* 5. Is there another phone number where we can reach you?

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* 6. May we text you with class reminders and updates?

Yes

Phone number for text messages.

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* 7. What is your email address?

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* 8. What is your gender?

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

Yes

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* 10. How would you describe yourself?

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your zip code?

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* 4. What is your phone number?

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* 5. Is there another phone number where we can reach you?

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* 6. May we text you with class reminders and updates?

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* 7. What is your email address?

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* 8. What is your gender?

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

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* 10. How would you describe yourself?

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* 11. How many people live and/or routinely eat meals in your home?