2024 Meal Box Enrollment

First Name

Last Name

Address Line 1

Address Line 2

City

State

Postal Code

What are your preferred primary language(s)?

The following questions help us show how we’re supporting our community members, and help us improve our programming. Your answers are private and confidential and will not be shared with anyone.If you feel uncomfortable answering any of the questions, you do not have to respond. Thank you!

What best describes your gender?

Please Specify:

What is your current age?

With which racial and ethnic group(s) do you identify? (mark all the apply)

Please Specify:

In which of the following ranges was your household income last year?

Our meal boxes are currently being offered for free, but if you could, would you pay to participate?

YesNo

How much would you budget for a weekly food box of two recipes each making 6 servings?

Number of people currently living in your household:

Number of people under 18 currently living in your household:

Within the past month, we worried whether our food would run out before we got money to buy more.

YesNo

Within the past month, the food we bought just didn’t last and we didn’t have money to get more.

YesNo

If you answered yes, how many days did this happen in the last month?

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I feel comfortable reading and following a new recipe.
I feel comfortable performing common kitchen tasks such as measuring ingredients and chopping vegetables.
I feel comfortable in the kitchen and preparing meals at home.

Contact Information