Gator Groceries Registration & Survey

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All SF State students who are interested in participating in the food pantry/food cupboard for Fall 2019 are required to register through this form to access the pantry. Please note that all information required on this form will help us to provide a better service for you and all individual answers are kept confidential within Associated Students Productions.

Email *

First and Last Name *

Student ID # *

Where do you currently live? *

On Campus Housing

Off Campus

Other:

During the last 12 months, was there a time when: You were worried you would run out of food because of a lack of money or other resources? *

Yes

During the last 12 months, was there a time when: You were unable to eat healthy and nutritious food because of a lack of money or other resources? *

Yes

During the last 12 months, was there a time when: You ate only a few kinds of foods because of a lack of money or other resources? *

Yes

During the last 12 months, was there a time when: You had to skip a meal because there was not enough money or other resources to get food? *

Yes

During the last 12 months, was there a time when: You ate less than you thought you should because of a lack of money or other resources? *

Yes

During the last 12 months, was there a time when: You ran out of food because of a lack of money or other resources? *

Yes

During the last 12 months, was there a time when: You were hungry but did not eat because there was not enough money or other resources for food? *

Yes

Select which best describes access to a local grocery store: *

I have access to personal/public transportation to my local grocery store

I do not have reliable access to personal/public transportation to my local grocery store

Do you currently qualify and/or participate in any of the following? *

Calfresh

Another local food pantry organization

Other; please explain

None

Other:

Required

If none, would you be interested in learning more about how to register for Calfresh or other additional off-campus resources for food access? *

Yes

Which of these do you have access to? *

Stove

Refrigerator

Microwave

Toaster

Oven

Stove Top

Hot Plate

Pantry

Required

How did you hear about the food pantry? Check all that apply *

Flyer

Friend/Classmate

Classroom Presentation

Program Referral

Other:

Required

What program(s) are you a member of? Check all that apply *

Associated Students Project Connect

Associated Students Project Rebound

Associated Students Early Childhood Education Center

Athletics Program

DPRC

Dream Resource Center

EOP

Guardian Scholars

Health Promotion and Wellness Center/ CalFresh

METRO Academies

Veteran's Center

Associate Students

Other:

Required

Did you experience any hesitation signing up for this program? *

If yes, please check all that apply

Stigma or embarrassment

Difficulty carrying or transporting items

Homelessness

Limited access

Difficulty of time involved with registering

Other:

Required

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