Language
English (US)
Spanish (Latin America)
Food Recipient Survey
Please take a moment to fill out this survey to help improve our services. Your feedback is appreciated!
If selected how can we reach you? (type in a phone or email)
*
Number of children (0-17) in your household
*
Number of adults (16-64) in your household
*
Number of seniors (65+) in your household
*
How would you rate the QUALITY of the food you receive?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate the VARIETY of the food you receive?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How would you rate the respectfulness and friendliness of our staff and volunteers?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Have you ever been unable to receive food due to supply shortages?
*
Yes
No
Is there anything specific you would like to see more of in our food selection?
Any additional comments or suggestions improve our service?
Are you interested in being a part of Client Advisory Committee? (If yes, enter email for us to reach you)
example@example.com
Submit
Should be Empty: