On behalf of Second Harvest Food Bank, thank you for taking the time to complete this survey. This survey is to determine eligibility in the grocery home delivery program, Groceries on the Geaux. Please note, there are geographical and other limitations. 

Survey information is shared with Second Harvest and a third party organization to determine program approval.

If you wish to be considered for this program, please answer the following questions.

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* 1. Please enter your contact information below.

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* 2. What is your date of birth?

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* 3. How many people live in your household?

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* 4. Do you have reliable transportation?

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* 5. Do you receive SNAP (also known as Food Stamps)?

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* 6. Do you or anyone in your home have the ability to prepare a meal?

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* 7. Please select how true the following statement was for your household over the past 12 months.
"We have worried our food would run out before we got more money."

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* 8. Please select how true the following statement was for your household over the past 12 months.
"The food we bought just didn't last, and we did not have money for more."

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