Pre-Survey - Healthy Nutrition

Global Tech Education Wellness Survey

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*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Name
Do you work in any of the following?
18-25 years old26-35 years old36-45 years old46-59 years old60+Other
Food Security Questions
I feel secure using my smart phone and email to order food and groceries online.

1

2

3

4

5

1 is Worst, 5 is Best

Rate Your Knowledge and Capacity to Healthy Food and Nutrition*

Rows	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 immediate overall health?
Plant-based, vitamins, medication, etc.
What recommendations would you make to improve community wellness?
Leadership teamOutreachSocial MediaProgrammingAdvocacy groupVolunteerParent ClubAdministrationRevitalizationFundraisingOther
Should be Empty:

Global Tech Education Wellness Survey