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The BEET Food Access Survey
1.
Which of the following, if anything, stops your family from buying the food you need? (Read each choice. Check all that apply.)
Nothing. I can afford all the I need
Rent/Mortgage
Utilities
Medical bills / Prescription costs...
Cost of Childcare
Getting transportation to the store
Being treated poorly at stores
Other (please specify)
None of the above
2.
Which of these, if any, have you or those in your household used in the last year? (Read each choice. Check all that apply.)
Food stamps (SNAP)
Food banks/food pantries
WIC
Shelter that provides food
School lunch and/or breakfast program
Summer food service programs such as at a school or community center
Nutrition program for the elderly
Other (please specify)
None of the above
3.
How many days does the food last you get from the assistance program usually feed your family?
How many days does the food last
One to Two
Three to five
Six or more
Other (please specify)
None of the above
4.
How many weeks does the food last you get from the assistance program usually feed your family?
One to Two
Three to five
Six or more
Other (please specify)
None of the above
5.
Which of the following problems, if any, did I have in using the food assistance program? (Read each choice. Check all that apply.)
The application process was hard
The food provided was not of good quality and/or variety
Did not meet my dietary needs
Did not meet my cultural needs
It was hard to get to the food assistance program named:
You were treated poorly when applying for assistance
You were treated poorly when using assistance
There was a barrier to your language:
Other (please specify)
None of the above
6.
How many times per month do you eat food made at each of these places?
Food made from scratch at home?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Fast food or restaurant take out?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Eat-in restaurant food?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Food provided by school cafeterias?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Food from convenience or gas stores?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Food served at church or community service organizations?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Food served at a workplace cafeteria?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
Food from a vending machine?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
How often do you eat food made at another place?
-- Select an option --
Everyday
2-3 times a week
Once month
Other
Never
If you eat food made at other places then listed above please list those place
7.
If you haven’t used a food assistance program in the last year? (Read each choice. Check all that apply.)
I am not eligible because of income or assets
I am not eligible due to disability
Because of my citizenship or someone in my household
Other people need benefits more than I do
Don't know how to apply
It's too hard to get to the place where I go to apply
It's too hard to get to the place where I get assistance
I don't want to go through the application process because it is too long / too hard to complete
I don't want to go through the application process because it asks too many personal questions
Other (please specify)
None of the above
8.
How often do you eat fruits or vegetables? (Fresh, Frozen or Canned) (Read each choice. Check only one.)
Frequency once a week or less
2-4 times a week once a day
2-4 times a day
5 or more times a day
9.
Which of the following problems, if any, stops you from eating the fruits and vegetables you want? (Read each choice. Check all that apply.)
Prices are too expensive
Stores are too hard to get to
Fruits and vegetables are of poor quality where I shop
Fruits and vegetables you want are unavailable where I shop
Not enough time to shop for fruits and vegetables
Not enough time to prepare fruits and vegetables
No kitchen or equipment to prepare/store fruits and vegetables
I don't like fruits and vegetables
Not enough fruits and vegetables to feed everyone in my home
Other (please specify)
None of the above
10.
How many children in your household do you provide for on a daily basis?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
11.
How many of these children are in:
Preschool: 0-4 years old:
Elementary school: K-6th grade :
Middle school: 7th-8th grade :
High school: 9th-12th grade:
12.
How many adults 18 or older, including yourself (if applicable), currently live in your household? (Check only one.)
None
1
2
3
4
5 or More
13.
Briefly share what types of supports or services would best support your
FAMILY
with food access? (Examples, accessing multiple food boxes, more affordable access to foods etc.)
14.
Briefly share what types of supports or services would best support your
COMMUNITY
with food access? (Examples, community garden boxes, cooking classes, nutrition education classes.)
Current Progress,
0 of 14 answered
