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Double Up Food Bucks Michigan - Participant Survey
Thank you for answering a few questions about your experience as a
current Double Up Food Bucks participant
in
Michigan
. We use the information you provide to help improve Double Up Food Bucks for everyone.
*
Contact Information
(Required.)
First Name
*
Zip Code
*
Your Email
*
Phone Number
What suggestions for improvement or questions do you have about Double Up Food Bucks?
*
How did you hear about Double Up?
Please check all that apply.
(Required.)
Mail to my home
Friend or family
Community organization
Healthcare provider
E-mail
Social media
Advertisement (such as a billboard or bus)
MDHHS office
In the news
At a participating location (on a flyer or poster)
Other (please specify)
*
Do you have SNAP/food stamps?
Please check one.
(Required.)
Yes
No, but I think I qualify
No, I don't qualify
*
How long have you been a Double Up shopper?
Please check one.
(Required.)
1-6 months
7-12 months
1-2 years
2-5 years
More than 5 years
I'm not currently a Double Up shopper
*
What is the best way for Double Up to share information in your community?
Please check all that apply.
(Required.)
Text message
E-mail
Social media
Double Up Food Bucks website
Hotline
Other (please specify)
(Optional) Please tell us more about your story using Double Up Food Bucks.
Please check the following if...
(check all that apply):
You would like a Double Up Food Bucks staff member to follow up with you about any questions or concerns you raised
You would be willing to share your story about using Double Up Food Bucks with others
You would like to join our mailing list to receive more information about the program from time to time
*
The feedback that you provided about the program will only be shared with staff and program partners without any identifying information other than your first name. However, Fair Food Network would like your permission to use positive quotes from your survey responses in Fair Food Network’s publications such as brochures, direct mail, print advertising, newsletters, display boards, social media accounts, and website or other forms of media. We would like permission to use your first name and city to associate with your quotes.
Learn more about the terms and conditions.
(Required.)
Yes, Fair Food Network has my permission to use my quotes.
No, Fair Food Network does not have my permission to use my quotes.
Optional:
Are you willing to share more about your experience with us in addition to what you shared on this form?
Yes, Fair Food Network can reach out to me. I would like to share more of my story and/or experience with Fair Food Network’s programs and Fair Food Network and/or our program partners have permission to contact me.
None of your information will be sold to third-party advertisers or services.