Make a Difference Survey

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Thank you for taking the time to help us learn more about the needs of the Food Allergy Community!

Tell us more about yourself - check all that apply: *

I have a food allergy.

I am the parent/guardian of someone with food allergy.

I am the family member of someone with food allergy.

I work with children with food allergy.

I work with adults with food allergy.

I want to support the food allergy community.

Other:

Required

If you checked "Other" above or would like to elaborate - please do so here:

Where do you live? *

Locally - Duluth/Hermantown

"The Northland"

Other:

Required

If you answered, "Other" or "The Northland" could you specify State or City?

Choose the TOP 2 initiatives that you think would help the food allergy community today: *

New Diagnosis Support

Parent Support Group

Child Support Group

School Initiatives engaging fellow students/teachers/staff

Local Restaurant Guide

Park Signage reminding visitors to clean tables + hands

Allergy Aware Entertainment Venue seating/options

504 Advocate - help with planning + prep for meeting

Other:

Required

If you answered "Other" above, please explain here:

Are you interested in volunteering? *

Yes

Maybe

Is there anything else you'd like to share with ALEIA Project?

Submit

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