Melrose/Wakefield Community Food Assessment Survey
For Adults and Senior Citizens
What is your zipcode?
Do you identify as any of the following?
To which racial group(s) do you most identify?
Clear selection
What is your annual household income?
Clear selection
Do you use any of the following?
How many seniors (65 years and older) do you shop for, including yourself?
Clear selection
How many adults (18-65 years old) do you shop for, including yourself?
Clear selection
How many children (17 years and younger) do you shop for, including yourself?
Clear selection
Where do you shop for the majority of your groceries?
Clear selection
Where else do you get your food?
What are the main problems getting your food? (Choose all that apply.)
Which of the following would help you get the food you need? (Choose all that apply.)
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