Saba Grocer's Initiative
Sign up to receive $5 dollars for every $1 you spend on fresh produce! After you fill out this form you will be re-directed to Fresh Incentives, where you can create your Fresh 5x account.
Survey Disclaimer / Descargo de Responsibilidad
This survey is confidential and intended solely for the use of Saba Grocers. The following questions will be used for general research use only. This survey does not contain information that can identify you. No one outside of the organization will have access to this data. Esta encuesta es confidencial y está destinada exclusivamente al uso de Saba Grocers. Las siguientes preguntas se utilizarán únicamente con fines de investigación general. Esta encuesta no contiene información que permita identificarle. Nadie fuera de la organización tendrá acceso a estos datos.
Total number of people in your household (e.g., 3)? ¿ Número de personas en el hogar? (e.g.,3)?
Number of children under 5 years old? Número de niños menores de años?
Number of adults over 65 in your household? Número de adultos mayores de 65 en su hogar?
Employment Status. Estado de empleo.
Employed full-time/ Empleado(a) tiempo completo
Employed part-time/ Empleado(a) tiempo parcial
Unemployed/ Desempleado(a)
Retired/ Jubilado(a)
Prefer not to answer / Prefiero no responder
How old are you? Cuantos años tiene?
What is your gender? Cuál es tu género?
Woman / Feminino
Man / Masculino
Other / Outro
Prefer not to answer / Prefiero no responder
What is your race and/or ethnicity? Select all that apply. ¿ Cual es su raza o etnicidad? Seleccione todas las opciones con las que se identifique.
American Indian or Alaska Native (for example, Ohlone, Chochenyo, Karkin, Graton Rancheriaetc.)
Asian (for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)
Black or African American (for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)
Hispanic or Latino (for example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)
Middle Eastern or North African (for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, etc.)
Native Hawaiian or Pacific Islander (for example, Native Hawaiian, Samoan, Tongan, Fijian, Marshallese, etc.)
White (for example, English, German, Irish, Italian, Polish, Scottish, etc.)
Prefer not to answer / Prefiero no responder
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