This survey is voluntary, anonymous and confidential.  Your participation will help us to improve our programs.

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* 1. What is your zip code?

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* 2. In the last year, how frequently have you or your family received food assistance from:

  Often Sometimes  Never
Food Pantry
WIC
SNAP (food stamps)
Community meals (provided by faith communities, civic groups, etc.)
Meals through Senior Centers
Free or reduced school lunch or breakfast
Weekend back pack/meal programs
Fresh Connect
Commodity supplemental food program (CSFP) Senior food boxes
Farm to Families
Meals on Wheels
MANNA (medically tailored meals)

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* 3. What is your Race? 

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* 4. Are you Hispanic/Latinx?

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* 5. What is your sex?

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* 6. Total Number of People Living in your household

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* 7. Number of Children under 18

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* 8. Number of Adults 18-59

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* 9. Number of Seniors 60+

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* 10. Is anyone in your household currently employed

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* 11. What is your annual household income

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* 12. When combining all of your food resources (including SNAP, cash, pantries, etc.) are you:

  Strongly Disagree (never) Disagree (most likely no) Neutral (unsure) Agree (most likely yes) Strongly Agree (always)
Able to get the quantity of food you need to feed your family?
Able to get the quality of food you want to feed your family?

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* 13. How deeply were you or your family negatively impacted by the pandemic financially?

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* 14. If you were impacted financially by the pandemic, to what extent have you or your family recovered?

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* 15. Are any of these impacting you or your family’s ability to buy enough food currently? (Check all that apply)

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* 16. Do you or does anyone in your household have a chronic medical condition such as diabetes, high cholesterol, heart disease or high blood pressure?

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* 17. Has your health care provider recommended a special diet for you or a household member's health?

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* 18. If yes, are you able to follow that special diet with the food assistance that you receive?

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* 19. Do you currently follow any of these diets?

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* 20. If you follow one of the diets in the previous question, are you able to obtain these foods with the food assistance you receive?

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* 21. Prior to the pandemic, were you receiving any type of assistance with food (including SNAP, WIC, food pantries, Fresh Connect, etc.)?

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* 22. Are you currently receiving SNAP benefits?

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* 23. If you are not currently receiving SNAP benefits, why not? (check as many as apply)

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* 24. DURING THE LAST MONTH how often did any of these apply to the food situation in your home?

  Often Sometimes or at least once Never
Did you worry about running out of food?
Did anyone in your household skip or eat smaller meals because there wasn't enough food?
Did anyone in your household go for a whole day in the last month without eating due to lack of food?
Were you able to eat a healthy, balanced meal three times a day?

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