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?
2.In the past year in your home: (Please check only one.)
3.Please check all that apply to your food situation over the past year
4.Has there been a time when you did not have enough food for yourself or your household?
5.If you answered 'Yes' to the previous question, how often has your food supply been inadequate?
6.How often would you need to access a food pantry?


7.What day of the week would you want a pantry to be open? (choose one)
8.Which hours of operation would be most convenient for you based on your schedule?
9.How likely would you come to a food pantry if it was open 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.
If people you know were in need, do you think they would use a food pantry?
Is a food pantry is a need in the River Valley Community?
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
A community meal
Nutrition education
Clothing 
Job information
Personal Hygiene Items 
Household items (ex. paper towels, toilet paper)