Mobile Pantry Guest Survey

1
How does your household identify?* This field is required.Choose all that apply.
Native American, American Indian, or Alaskan Native
Asian, South Asian, or Southeast Asian
Black or African American
Hispanic, Latinx, or Spanish origin
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Bi-racial/Multi-racial
Prefer not to say
Other
2
How many people live in this household?* This field is required.
3
Please indicate how many people of each age group is in the household.* This field is required.
# of People in Household
Ages 0 - 5
Row 0, Column 0
Ages 6 - 12
Row 1, Column 0
Ages 13 - 17
Row 2, Column 0
Ages 18 - 24
Row 3, Column 0
Ages 25 - 44
Row 4, Column 0
Ages 45 - 64
Row 5, Column 0
Ages 65+
Row 6, Column 0
Ages 0 - 5
Ages 6 - 12
Ages 13 - 17
Ages 18 - 24
Ages 25 - 44
Ages 45 - 64
Ages 65+
# of People in Household
Row 0, Column 0
# of People in Household
Row 1, Column 0
# of People in Household
Row 2, Column 0
# of People in Household
Row 3, Column 0
# of People in Household
Row 4, Column 0
# of People in Household
Row 5, Column 0
# of People in Household
Row 6, Column 0
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4
Please indicate how many people of each gender is in the household.* This field is required.
# of People in Household
Female Identifying
Row 0, Column 0
Male Indentifying
Row 1, Column 0
Female Identifying
Male Indentifying
# of People in Household
Row 0, Column 0
# of People in Household
Row 1, Column 0
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5
How many veterans are in the household?
6
Any dietary restrictions in the household?
Huge
Large
Normal
Small
Ok
Ok
7
Any suggestions for the mobile pantry?
Huge
Large
Normal
Small
Ok
Ok
8
On a scale of 1-5, how would you rate the overall experience with the mobile pantry?
1
2
3
4
5
Should be Empty: