Local Nutrition Education Survey
Thank you for taking this survey on behalf of Global Technology Education LLC! The purpose of this survey is to assess what our community already knows about healthy foods and how you are exercising healthier behavior to improve your overall higher "quality of life".
Today's Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church. Company or Organization Name
Who referred you to complete the Survey?
Knowledge and Attitudes About Health Eating
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Strongly Agree
Agree
Neither
Disagree
Strongly Disagree
Eating healthy is important to my overall mental, spiritual, and physical well-being
I have access to stores in my neighborhood to buy healthy food
I know how to make a really healthy meal
I intentionally exercise for 20 minutes at least two times per week
I would like to learn more about how to eat purchase and prepare healthier produce / meals
I believe healthy foods are more expensive in my neighborhood
I know how to budget when I grocery shop for food
I believe access to "fresh, health foods" is limited in my neighborhood
I eat fruits, vegetables and whole grains often
I drink plenty of water throughout the day
Most times, I drink water from the faucet, not bottle water
What steps are you taking to improve your overall health?
What recommendations would you make to improve community wellness?
Would you like to join a committee?
Leadership team
Outreach
Advocacy group
Volunteer
Parent Club
Administration
Revitalization Committee
Funraise
Other
What is your age group?
18-25 years old
26-35 years old
36-45 years old
46-59 years old
60+
Other
Submit
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