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Please take 5-10 minutes to complete the following survey so that we can tailor our programming to your wants and needs (or those of your doctor).
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About You
Name:
*
Your answer
Email:
*
Your answer
Should we contact you directly with information about course offerings and special events?
*
Yes!
No, thanks. I'll check for class offerings on the YMCA website.
Phone #:
Your answer
Age:
*
Your answer
Gender:
*
Your answer
Number of children under 18:
*
Your answer
Are you a member of the East Boston YMCA?
*
Yes
No
Does anyone in your family receive the following (check all that apply):
SNAP/EBT/Food Stamps
WIC
Current Habits
Where do you currently shop for fresh food?
*
East Boston Farmer's Market
Community Supported Agriculture (CSA) share
Shaw's, Market Basket, or other large grocery store
Convenience Store
Other:
Required
About how many servings of fruit and vegetables do you eat per day?
*
(1 serving = 1 piece of fruit such as a peach, 1 cup of leafy greens, or 1/2 cup of other vegetables such as carrots)
1
2
3
4
5
6
7
8
9
More
About how many times per week do you eat a meal prepared at home?
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0
1
2
3
4
5
6
7
8
9
More
What limits you from cooking more at home?
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I don't have the time.
Cooking is too expensive.
I don't know how to cook.
I don't have the proper equipment.
Someone else does it for me.
I haven't taken a class at Ashley Street Teaching Kitchen yet!
I cook plenty at home, the kitchen is my happy place.
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