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WIC Clients Community Discussion via Zoom

Welcome!
This is the registration form for a WIC Discussion taking place via Zoom. This discussion is only for Illinois residents currently enrolled in WIC.
We're interested in your experience with the WIC program, including any opinions or perceptions you have of the program, why you chose to enroll, and what could make the program work better for you.  Your feedback will be used to strengthen the WIC program in Illinois and we would love your input and recommendations.
 
Below we have a few questions asking which possible dates would work best for you to attend a discussion and how to get in touch with you. We'll pick the date that works for the most people and notify you in advance.

The information you provide here will not be shared out with other people and is simply for the purposes of scheduling your participation in the discussion. If you participate in the discussion, the contact information you provide here will be used to mail a $50 Visa gift card in appreciation for your valuable time and insights.

Thank you so much!

Greater Chicago Food Depository 

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* 1. What ZIP Code do you live in?

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* 2. What is your name (first name, last name)? We will not share your name with anyone else.

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* 3. Which dates and times are you available for a one and a half hour discussion (check all that apply)?

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* 4. Would you prefer a discussion group in English or Spanish (Espanol)?

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* 5. Please provide your 10 digit telephone number below so that we may text you to schedule the discussion. We will not reach out to you for any other reason without your permission (standard data rates apply).

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* 6. Please provide your email address below so that we may contact you to schedule the discussion. We will not email you for any other reason without your permission.

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* 7. Please be aware that our discussion will be recorded for note taking purposes. We will not share the recording or notes with anyone else. Once notes are complete, we will destroy the recording. Do we have your permission to record the discussion?

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* 8. Please provide your street address so that we can mail a $50 Visa gift card to you in appreciation for your time and insights during the discussion. We will not contact you at this address for any other reason without your permission.

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