Questionnaire - Food Bank of Contra Costa and Solano

Food Stamp ChallengeSummary QuestionnaireThanks so much for participating in the Food Stamp Challenge and for sharing your experienceby completing this brief questionnaire. If you have any questions, please contact VeronicaWimer at 925-676-7012 or vwimer@foodbankccs.org.1. Participant's age: 15-22 23-35 36-50 51 +2. Were you able to complete the challenge at or under the $20 budget? Yes No3. Were you able to purchase most of the same food items that you typically buyfor yourself and your family on a regular basis? Yes Noa. If not, what items did you miss most of those that you were unable to purchase?4. Where you able to purchase any fresh produce items during the challenge?a. Can you tell us about any decisions you had to make about purchasing fresh, frozen, orcanned fruits and vegetables?5. How long did it take to shop for affordable food items compared to your normal foodshopping time? Shorter Longer About the sameComments:

6. Was there a time difference in preparing your meals during the challenge compared toyour normal food preparation time? Shorter Longer About the sameComments:7. Did you have any difficulties around eating on the budget when away from home, suchas at work or during meetings? Yes NoComments:8. Did you eat out during the food stamp challenge? Yes Noa. If yes how much did you spend?b. If no, why not?9. How would you rate your overall physical health during the challenge week? I had less energy and didn't feel like my normal self. I felt about the same as I usually do. I was more energetic and felt better than I normally do.10. Are there any other comments about the challenge that you would like to share?Name:Email address:Phone number:Mailing address:This information will be kept confidential. I would be interested in speaking to the media about my experience with the FoodStamp Challenge. Please add me to the Food Bank of Contra Costa and Solano mailing list. Please add me to the Food Bank of Contra Costa and Solano e-news alert list.Please return your completed questionnaire to Veronica at vwimer@foodbankccs.org or925-671-7933 (fax).