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* 1. Organization Name

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* 2. Primary Contact Person for the Coalition:

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* 3. Please list all of the current services you provide related to food insecurity:

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* 4. What EBR zip codes do you primarily serve?

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* 5. Which of the subgroups you are interested in engaging with: (check all that apply)

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* 6. What is the reason you are engaged in the coalition? (check all that apply)

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* 7. How much do you agree with the following statement being the guiding principle of the coalition:

Decrease the number of working poor people in EBR experiencing food insecurity by connecting coalition to the local, state and federal financial and data/evaluation resources available aimed at accessing food. The coalition will prioritize securing financial resources for sustainability, utilization and collection of data to highlight the need, call to actions on policy improvements, and alignment of food resources and distributions to the need.

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* 8. Is there something missing from the statement above?

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* 9. What are you hoping to gain from your involvement in the coalition? Please share your top 3 desired short term outcomes and any long term outcomes as well.

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* 10. What resources do you have that can be leveraged by the coalition? (relationships, resources, data, people, etc.)

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* 11. What organizations or people are missing from the coalition? Please provide contact information if available.

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* 12. Are you in favor of: (check all that apply)

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* 13. What are the current and potential strengths of the coalition?

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* 14. What are some areas of improvement for the coalition?

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* 15. Are you able to access a google group and google drive to see coalition materials in one location?

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* 16. List additional individuals with emails from your organization that you would like to engage in the coalition.

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