CMAT Survey Test Page

Cooking Matters

Cooking Matters at the Store Video Tour

Name(Required)

Gift Card

If you would like to receive a gift card for participating, please provide your contact information below (this is only available for people living in Idaho):
Address

Survey

What gender do you identify as?
What is Your Age?
What is the highest Level of education you have completed?
Are You Hispanic or Latino?
What is your race? (You may mark more than one.)
Are you pregnant?
How many people TOTAL counting yourself live in your household? (This may include non-relatives who live with you.)
How many children ages 6-17 live in your household? (This may include non-relatives who live with you.)
How many children ages 0-5 live in your household? (This may include non-relatives who live with you.)
Have you or other members of your household participated in any of the following programs in the last year? (Check all that apply)
This idea is not for meI'm thinking of trying in the next 6 monthsI'm planning on trying this on my next shopping tripI already did this before the tour
Waste of timeIt doesn't make that much differenceIt's OKIt's a good ideaThe only way to go
Waste of timeIt doesn't make that much differenceIt's OKIt's a good ideaThe only way to go
Waste of timeIt doesn't make that much differenceIt's OKIt's a good ideaThe only way to go
Waste of timeIt doesn't make that much differenceIt's OKIt's a good ideaThe only way to go
Overall, what did you think about this tour?
How would you prefer to receive nutrition education in the future?
This field is for validation purposes and should be left unchanged.