JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
The Low Waste Kitchen Registration and Pre-Evaluation Survey
Thank you for registering for the class. Your information is confidential and will only be used for program planning and evaluation purposes.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First and Last Name
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Mailing address
*
Your answer
We would like to send you reminders of the upcoming classes or additional resources to enhance the class topics. What is your preferred contact method?
email
Phone call
text
mail to home or PO box
How did you hear about the class?
*
Facebook
Flyer
Personal Invitation
Friend
Email
Other:
Do you participate in any of the following programs?
WIC
SNAP (CalFresh)
Food Bank/Pantries
Tribal Food Assistance
Seamless Summer Meal Program
Farmers Market Market Match Program
Other:
What is your gender?
Female
Male
Prefer not to say
Other:
Clear selection
What category below includes your age?
16-29
30-39
40-49
50-59
60 or older
Clear selection
What race/ethnicity do you best identify?
Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to respond
Unknown
more than one race/ethnicity
Clear selection
Have you ever used the Zoom application?
Yes
No
Clear selection
Which social media platforms do you use? Mark all that apply
Facebook
Youtube
Instagram
Twitter
Snapchat
Pinterest
Other:
Which device are you planning to use to access to the class?
Smart phone with camera
Computer without video
Computer with video
Clear selection
Over the last week, how much of the following foods have you (and your family) thrown away (either in a trash bin, compost bin, curbside compost service, garden, fed to pets, down the sink, etc.)
A lot
Some
A little
None
Don't eat
Fruits, vegetables or salads
Bread, cake or dessert products
meat or fish products
Cheese or yogurt
Milk or fruit juice
ready to eat, convenience or other snack foods
leftovers from meals
moldy or expired foods
A lot
Some
A little
None
Don't eat
Fruits, vegetables or salads
Bread, cake or dessert products
meat or fish products
Cheese or yogurt
Milk or fruit juice
ready to eat, convenience or other snack foods
leftovers from meals
moldy or expired foods
Check your top 3 reasons for throwing away food
I bought more food than I need
I did not make time to prepare and cook the food before it spoiled
I buy food and then my plans change
The food is past its best by or use by date
Other
Clear selection
What is your attitude towards dates labeled on packaged foods? Marked any that apply:
It's helpful for me to know when the food is no longer safe to eat
I use it as a guide to know how old the food is, but it still check food to see it is safe to eat before throwing it away
I rarely cook at the date printed on food and eat if it looks or smells safe to eat
I think the dates are confusing
How confident is your household in the following activities?
Very confident
Somewhat
Not very confident
How much food to buy and prepare for your family
How to store food properly in your kitchen and fridge
What to do with extra food or leftovers
Very confident
Somewhat
Not very confident
How much food to buy and prepare for your family
How to store food properly in your kitchen and fridge
What to do with extra food or leftovers
Clear selection
Is there anything in particular, about reducing food waste, you want to learn more?
Your answer
This class will be live-streamed via Facebook Live. You have an option to rename or turn off your video in a zoom setting if you choose to. Please check the media consent statement.
I consent to participate in the Waste Less Kitchen classes via a zoom with Facebook Live streaming. I am aware of my video, audio, or chat can be visible via Facebook Live streaming.
I do not consent to participate in the Waste Less Kitchen classes via a zoom with Facebook Live streaming. I am aware of my video, audio, or chat can be visible via Facebook Live streaming.
Clear selection
CalFresh Healthy Living program can send you the Food Smarts Waste Reduction coursebook in either pdf format via email or mail you a hard copy after the three-part series completion. Please mark all that apply.
Please send me only the pdf copy of the coursebook via email.
Please mail me the hard copy of the coursebook.
Please send me both the pdf and the hard copy of the coursebook.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of County of Del Norte.
Report Abuse
Forms
