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Food Pantry Questionnaire
1.
Have you ever experienced food insecurity, that is, not knowing where your next meal is coming from, or involuntarily eating less than you need, on a regular basis, for a period of time lasting more than a month?
Yes
No
2.
In the past year in your home: (Please check only one.)
We have had enough of the kinds of foods we like to eat
We have had enough food but not always the kinds of food we like to eat
At times we did not have enough to eat
We often do not have enough to eat
Don’t Know
3.
Please check all that apply to your food situation over the past year
Didn't have enough money for food
Someone in my household needs special foods due to a health condition
No working stove
No working refrigerator
Do not know how to make the healthy foods for my family
We cannot get to the store because of transportation or other reasons
Haven't had any problems getting enough food
Other
4.
Has there been a time when you did not have enough food for yourself or your household?
Yes
No
5.
If you answered 'Yes' to the previous question, how often has your food supply been inadequate?
0-1 times per month
2-4 times per month
5-6 times per month
7+ times per month
6.
How often would you need to access a food pantry?
Bi-Weekly
Monthly
Rarely
Not at all
7.
What day of the week would you want a pantry to be open? (choose one)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8.
Which hours of operation would be most convenient for you based on your schedule?
9am-12pm
1-4pm
After 5
9.
How likely would you come to a food pantry if it was open on a Saturday?
Likely
Unlikely
I wouldn't go on a Saturday
10.
Rate your agreement with the following statements:
Agree
Neither Agree or disagree
Disagree
If I did not have enough food, I would use a food pantry.
Agree
Neither Agree or disagree
Disagree
If people you know were in need, do you think they would use a food pantry?
Agree
Neither Agree or disagree
Disagree
Is a food pantry is a need in the River Valley Community?
Agree
Neither Agree or disagree
Disagree
11.
Some pantries offer other items and resources. Here are some items and resources that a pantry might offer. Please indicate if you would like a pantry to have the following item or resources available.
Yes
No
Already available somewhere else
Recipes
Yes
No
Already available somewhere else
A community meal
Yes
No
Already available somewhere else
Nutrition education
Yes
No
Already available somewhere else
Clothing
Yes
No
Already available somewhere else
Job information
Yes
No
Already available somewhere else
Personal Hygiene Items
Yes
No
Already available somewhere else
Household items (ex. paper towels, toilet paper)
Yes
No
Already available somewhere else
What types of non-food items would you recommend? Are there other items or resources you would like you pantry to offer?