ISNA Canada Foodbank - Feedback Survey

1
How many people, including yourself, live in your household?
1
2
3
4
5
6+
2
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
3
What is your gender?
Male
Female
Prefer not to say
4
How would you describe your cultural or ethnic background?
South Asian (e.g., Indian, Pakistani, Bangladeshi, Sri Lankan)
Southeast Asian (e.g., Filipino, Vietnamese, Thai, Cambodian)
Arab
Black (e.g., African, Afro-Caribbean, African Canadian)
East Asian (e.g., Chinese, Korean, Japanese)
Indigenous (e.g., First Nations, Métis, Inuit)
Latin American
Middle Eastern (e.g., Iranian, Turkish, Kurdish)
White (e.g., European, North American)
Prefer Not to Say
Other
5
Do any of the following descriptions currently apply to you?
Living with a disability
Unemployed
Experiencing a mental health issue
Single Parent
Experiencing homelessness
Grandparent who is taking care of Grandchild/Grandchildren
Experiencing addiction
Prefer not to say
Other
6
How many times have you visited the ISNA Canada food bank in the last 12 months?
This is my first time
2-3 times
4-6 times
more than 6 times
7
How many times have you visited the ISNA Canada food bank in the last 12 months?
This is my first time
2-3 times
4-6 times
more than 6 times
8
Do you visit any other food banks in addition to ours?*Your response will not affect your eligibility to receive food from our food bank. This information helps us better understand community needs*
No
Yes
Prefer not to say
9
Below is a list of items currently included in our food boxes. Which of these do you or your family use at home?
Basmati Rice
All-Purpose Flour
Red Lentils
Green Lentils
Chickpeas
Tomato Paste
Fava Beans
Lima Beans
Pita Bread
Mix Bread
Other
10
What food items would you like to see added to our food bank offerings?
Fresh Produce
Meat/Chicken
Cooking Oil
Breakfast items (e.g., cereal)
Baby food or formula
Canned fish (e.g., tuna or sardines)
Bread or wraps
South Asian spices (e.g., turmeric, cumin, garam masala)
Middle Eastern staples (e.g., za’atar, bulgur, fava beans)
Other
11
If this food bank could offer additional services or resources, what would you be most interested in? (select all that apply)
Clothing assistance
Job search or job readiness assistance (e.g., résumé writing, training)
Nutrition of other health information
Health screenings or exams (e.g., blood pressure, eye or dental exam)
Hygiene items (e.g., shampoo, deodorant, toothpaste)
Help signing up for assistance programs (e.g., Food Stamps, WIC,Medicaid, medication)
Transportation assistance
Mental health support (one-on-one counselling, support groups)
None - I'm not interested in additional services/resources
Other
12
Is there anything else you'd like share about your experience with the ISNA Canada Foodbank?
13
Name (Optional)
First Name
Last Name
Should be Empty: