Diaper Bank Survey

Diaper Bank Survey
We are collecting information from parents and caregivers who receive diapers from our diaper bank. The information collected will help us understand how providing access to free diapers helps you and your family. The survey will take about 10 to 15 minutes to complete.

Your answers will be completely anonymous. Choosing not to complete the survey will not affect your ability to receive diapers from us or your diaper bank partner. If you choose to begin the survey, you can stop and close the survey at any time.

Thank you for your time and participation!
Which partner agency provides you with diapers from our diaper bank?
What is your relationship to the child or children receiving diapers from the diaper bank/agency?

MotherFatherFoster ParentGrandmotherGrandfatherStepmotherStepfatherAuntUncleOlder Sibling over 18Other
How do you describe your race or ethnic identity?

American Indian or Alaskan NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific IslanderWhite/CaucasianMultiracialPrefer not to share
What is the number of children wearing diapers in your household?

12345
What zip code do you live in?
Are you currently working?

Full TimePart TimeUnemployed
Are currently in school?

Full TimePart TimeNot attending school
Did an adult in your household miss work/school when they did not have enough diapers for child care?

YesNo
How did you get to the agency today, or the most recent time you got diapers?

I walked.I used pubic transportationI drove myselfI got a ride from someone I knowI used a tax or ride sharing app like Uber or Lyft
How much was your total household income in 2022? Think about total combined family income for all family members. Include wages, salary, commission, bonuses or tips for all jobs. Choose the closest range
Did you receive any of the following cash assistance/benefit(s) listed below in 2022? (Check all that apply)

AlimonyChild SupportDisability (Veterans or Other)PensionSNAP / Food StampsSocial SecuritySSITANF / Cash AssistanceUnemploymentWICWorkers' CompensationOther Benefit
Receiving free diapers helps me save money for...
Is there anything you want us to know?
Would you be willing to share your story on how receiving diapers has helped your family?

Yes (Please complete the next set of questions.)No (Skip the next set of questions)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Best way to reach you?

EmailPhone
Best day(s) and time(s) to contact you?
Should be Empty: