The BEET Food Access Survey

Question Title

* 1. Which of the following, if anything, stops your family from buying the food you need? (Read each choice. Check all that apply.)

Nothing. I can afford all the I need

Rent/Mortgage

Utilities

Medical bills / Prescription costs...

Cost of Childcare

Getting transportation to the store

Being treated poorly at stores

Other (please specify)

None of the above

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* 2. Which of these, if any, have you or those in your household used in the last year? (Read each choice. Check all that apply.)

Food stamps (SNAP)

Food banks/food pantries

WIC

Shelter that provides food

School lunch and/or breakfast program

Summer food service programs such as at a school or community center

Nutrition program for the elderly

Other (please specify)

None of the above

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* 3. How many days does the food last you get from the assistance program usually feed your family?

How many days does the food last

One to Two

Three to five

Six or more

Other (please specify)

None of the above

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* 4. How many weeks does the food last you get from the assistance program usually feed your family?

One to Two

Three to five

Six or more

Other (please specify)

None of the above

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* 5. Which of the following problems, if any, did I have in using the food assistance program? (Read each choice. Check all that apply.)

The application process was hard

The food provided was not of good quality and/or variety

Did not meet my dietary needs

Did not meet my cultural needs

It was hard to get to the food assistance program named:

You were treated poorly when applying for assistance

You were treated poorly when using assistance

There was a barrier to your language:

Other (please specify)

None of the above

Question Title

* 6. How many times per month do you eat food made at each of these places?


Food made from scratch at home?	Food made from scratch at home? menu
Fast food or restaurant take out?	Fast food or restaurant take out? menu
Eat-in restaurant food?	Eat-in restaurant food? menu
Food provided by school cafeterias?	Food provided by school cafeterias? menu
Food from convenience or gas stores?	Food from convenience or gas stores? menu
Food served at church or community service organizations?	Food served at church or community service organizations? menu
Food served at a workplace cafeteria?	Food served at a workplace cafeteria? menu
Food from a vending machine?	Food from a vending machine? menu
How often do you eat food made at another place?	How often do you eat food made at another place? menu

If you eat food made at other places then listed above please list those place

Question Title

* 7. If you haven’t used a food assistance program in the last year? (Read each choice. Check all that apply.)

I am not eligible because of income or assets

I am not eligible due to disability

Because of my citizenship or someone in my household

Other people need benefits more than I do

Don't know how to apply

It's too hard to get to the place where I go to apply

It's too hard to get to the place where I get assistance

I don't want to go through the application process because it is too long / too hard to complete

I don't want to go through the application process because it asks too many personal questions

Other (please specify)

None of the above

Question Title

* 8. How often do you eat fruits or vegetables? (Fresh, Frozen or Canned) (Read each choice. Check only one.)

Frequency once a week or less

2-4 times a week once a day

2-4 times a day

5 or more times a day

Question Title

* 9. Which of the following problems, if any, stops you from eating the fruits and vegetables you want? (Read each choice. Check all that apply.)

Prices are too expensive

Stores are too hard to get to

Fruits and vegetables are of poor quality where I shop

Fruits and vegetables you want are unavailable where I shop

Not enough time to shop for fruits and vegetables

Not enough time to prepare fruits and vegetables

No kitchen or equipment to prepare/store fruits and vegetables

I don't like fruits and vegetables

Not enough fruits and vegetables to feed everyone in my home

Other (please specify)

None of the above

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* 10. How many children in your household do you provide for on a daily basis?

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* 11. How many of these children are in:

Preschool: 0-4 years old:

Elementary school: K-6th grade :

Middle school: 7th-8th grade :

High school: 9th-12th grade:

Question Title

* 12. How many adults 18 or older, including yourself (if applicable), currently live in your household? (Check only one.)

None

5 or More

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* 13. Briefly share what types of supports or services would best support your FAMILY with food access? (Examples, accessing multiple food boxes, more affordable access to foods etc.)

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* 14. Briefly share what types of supports or services would best support your COMMUNITY with food access? (Examples, community garden boxes, cooking classes, nutrition education classes.)