Worcester Food Storytelling Project Interest Form
Thank you for your interest in the Worcester Center on Food Equity 's storytelling project.

What we're doing:
We're documenting stories surrounding food insecurity and food access of Worcester residents. This project invites Worcester community members to share their experiences with food in Worcester.

Why we're doing it:
We hope that these stories will help us inform the future of food access and security in Worcester. 

What it will look like:
The material outcome of this project will be a digital archive of your story. This archive may include an audio and/or video clip of your story, pictures, and a short bio on you. 

How we'll protect you: 
Consent will be sought out in every step of the process so that anything that you do not want to be in the archive file will not be included. Nothing will be used that you don't approve of. We will protect your data.

What you'll get:
The Worcester Center on Food Equity is committed to honoring your time for your contribution to our project. To do this, we will provide a stipend of a $25 Visa gift card for participating in an interview.

Next steps:
To express interest in participating in this project, please fill out the form below. We will reach out to you when there is an opportunity for sharing your story with us. This will likely be at a one-on-one virtual Zoom session. We are looking forward to hearing from a diverse range of community members.

Please note that by filling out this form you are not committed or guaranteed to participate in this project, and are therefore not guaranteed to receive the stipend mentioned above. We will follow up with all responses in a timely manner.
What is your name? *
What zip code/area code of Worcester do you live in? (We are asking this to help us understand where need is greatest in Worcester.) *
What pronouns do you use? *
How do you describe your race? *
How do you describe your ethnicity? *
How old are you?  *
Do you identify as having a disability? *
Do you have accessibility needs you need to share with us? If so, please describe. *
Do you need a translator for our storytelling session?  *
If you answered yes to the previous question, please let us known for which language you will need a translator.
Do you have lived experience of food insecurity or difficulty accessing food? *
Have you ever been or are you currently enrolled in SNAP or WIC? *
We are prioritizing hearing stories from Worcester residents who would like to share in one of the below priority areas. Please check off which boxes you have experiences with that you would like to share with us.  *
Required
If you had to write a headline for the story you want to share, what would it be?
Why are you interested in participating in this project? Please provide a few sentences to share your thoughts. *
Contact Information
Please provide a phone number and/or email address so that we may get in contact with you.  We will not share your contact information with anyone, and we will only keep it as long as is necessary for this project.
How do you prefer we get in contact with you? *
Contact: *
Is there anything else you would like us to know?
Thank you! We'll respond to you shortly.
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