Copy 2of GCA Food Insecurity Question Title * 1. What are the last 5 digits of your Social Security number? OK Question Title * 2. How many in your household OK Question Title * 3. How long have you been a client of the Food Pantry Current year only 2-5 years 6-10 years 10+ years OK Question Title * 4. How important is the food support you receive from GCA. (1 lowest and 10 highest). 0 10 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 5. Since coming to the GCA Food Pantry how would you rate your food supply? Better About the same Worse OK Question Title * 6. How often do you come to Food Pantry? Every Month Every other month Every 3-4 months Occasionally (as needed throughout the year) Other (please specify) OK Question Title * 7. Have you ever missed a month of getting food for any of the following reasons? Lack of Transportation Medical/health Issues Food Pantry Closed when I can come No I have never missed a month OK Question Title * 8. Do you receive Food Stamps? No Yes If Yes how much? OK Question Title * 9. How would you rate the quality of services you receive from GCA? Poor Average Excellent Poor Average Excellent Additional Comments OK Question Title * 10. Would you be interested in attending a class at the Food Pantry? No Yes Maybe If yes or maybe what topics interest you? OK DONE