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1. Monthly Agency Statistics Survey

Agency Name and Agency ID?

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* 1. Agency Name and Agency ID?

What month are you reporting?

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* 2. What month are you reporting?

What type of food program?

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* 3. What type of food program?

Name of the person completing the survey

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* 4. Name of the person completing the survey

For meal programs, how many total meals (# of people served at each meal) were served this month?

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* 5. For meal programs, how many total meals (# of people served at each meal) were served this month?

What is the total number of people served MEALS for the first time this year?

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* 6. What is the total number of people served MEALS for the first time this year?

For Snack Programs, how many total snacks did you serve to each person this month (# of people multiplied by the number of times you served a snack)?

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* 7. For Snack Programs, how many total snacks did you serve to each person this month (# of people multiplied by the number of times you served a snack)?

What is the total number of people served SNACKS this month for the first time this year?

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* 8. What is the total number of people served SNACKS this month for the first time this year?

For pantry programs, what is the total number of households served this month?

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* 9. For pantry programs, what is the total number of households served this month?

What is the total number of people served at your PANTRY this month for the first time this year?

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* 10. What is the total number of people served at your PANTRY this month for the first time this year?

How many pounds were donated to your organization this month?
(Rule of thumb: 1 item = 1 pound)

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* 11. How many pounds were donated to your organization this month?
(Rule of thumb: 1 item = 1 pound)

How many pounds did you purchase at retail/wholesale stores this month?
(Rule of thumb: 1 item = 1 pound)

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* 12. How many pounds did you purchase at retail/wholesale stores this month?
(Rule of thumb: 1 item = 1 pound)

What Client Success Stories have you had this month?

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* 13. What Client Success Stories have you had this month?

Comments/Questions/Concerns?

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* 14. Comments/Questions/Concerns?

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