Feed the Pack Intake

Welcome to the Feed the Pack Food Pantry! We are a resource that provides supplemental food to NC State students, staff, and faculty who cannot afford healthy food for themselves or their families. You are required to finish this form before you can use the Feed the Pack Food Pantry. This intake form should take a maximum of 10 minutes to complete. This form contains personal and sensitive questions. Our team will keep your personal information private. We are collecting this information in order to learn how the pantry can best meet your needs and keep you updated on new changes in the pantry. This form also helps us to learn the causes of food insecurity in our community. Finally, the data from this survey helps us gain financial support from the community to continue to run the pantry.

Food insecurity is when someone is unable to afford or access enough food to live an active, healthy life on a regular basis. Food insecurity can have negative effects on your physical, emotional, and social health.

Feed the Pack is committed to reducing food insecurity on campus. We are also committed to ensuring every patron has equal access to our products. Thank you for completing this form so that we can better serve you! If you have any questions while completing this survey, please email feedthepackpantry@ncsu.edu.

First Name

Last Name

NCSU Email

9 digit NC State campus ID number

Please tell us your relationship to NC State

Are you a first generation college student? (You are a first generation college student if neither of your parents or legal guardians graduated with a four year degree)

Residency

Military Veteran

Feed the Pack is required to ask your address in agreement with one of our partner organizations. This information will not be shared directly with our partners. If your local address is different than your permanent address, please use your local address.

Address

Country

Street

City

Region

Postal Code

Feed the Pack Purpose and Community Guidelines

Food insecurity is when someone is unable to afford or access enough food to live an active, healthy life on a regular basis. For more information visit https://www.feedingamerica.org/hunger-in-america/food-insecurity.

Do you understand this definition?

Yes, I understand that food insecurity is not having enough money or access to food.

No, I still feel unclear about what food insecurity is.

Feed the Pack is a resource for food insecure NC State students, staff, and faculty. We do the best we can to serve our patrons as effectively and respectfully as possible. We ask our patrons to follow a set of community guidelines to make sure that we can provide each of our patrons with equal access to our resources.

1. Patrons can shop at Feed the Pack no more than once per calendar week.

2. Patrons must follow our category limits. Limits are posted outside of the pantry and are broken down by category. Categories include shelf stable items, produce, refrigerated items, frozen items, and non-food items. Category limits are also posted inside the pantry. Please ask a volunteer or shift leader if you have questions about the category limits.

3. Patrons must swipe their valid NC State ID when they enter the pantry, and must check out with a volunteer when they have finished shopping. When you enter the pantry, a volunteer will greet you and direct you to swipe your ID. When you finish shopping, you will be asked to place your basket on the scale on the volunteer station and let the volunteer know what produce you selected.

Select “Yes” below to confirm that you agree to follow our pantry rules.

Yes, I agree to follow the Feed the Pack pantry guidelines and I understand that they exist to make sure that there is enough food available for every patron that visits within the week. If I ever do not understand pantry rules or need to be reminded of them, I will ask a volunteer.

A goal of this intake survey is to collect information about how we can better serve our patrons. We have found that stories and experiences from our patrons help us collect more donations, find more volunteers, and develop more programs that fit the needs of our patrons.

Do you consent to the distribution of your written responses by Feed the Pack? For example, we may include quotes from your answers on our presentations, website, and flyers.

All of your identifying information will be removed before your responses are distributed.

Yes, I do consent to Feed the Pack using and distributing my written responses on this survey if all of my identifying information is removed.

No, I do not consent to Feed the Pack distributing my responses. They are for the Feed the Pack team only.

Were you aware that Feed the Pack patrons can also volunteer with us? If you would like to sign up to volunteer, please visit https://feedthepack.dasa.ncsu.edu/volunteer-information/.

Patron Experience with Food Insecurity

Answer the following questions about your experience with food insecurity to the best of your ability. Your responses will not be used to evaluate if you are eligible to use the pantry. They are for data collection purposes only. Please answer as honestly as possible.

For these statements, please indicate whether the statement was often true, sometimes true, or never true for (you/your household) in the last 12 months.

"I worry whether my food will run out before I get money to buy more.” Was that often true, sometimes true, or never true for (you/your household) in the last 12 months?

Often True

Sometimes True

Never True

"The food that I bought just didn’t last, and I didn’t have money to get more.” Was that often, sometimes, or never true for (you/your household) in the last 12 months?

Often True

Sometimes True

Never True

“I couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for (you/your household) in the last 12 months?

Often True

Sometimes True

Never True

How often in the last 12 months did you have to cut the size of your meals or skip meals because there wasn’t enough money for food?

Almost every month

Some months but not every month

Only 1 or 2 months

Never

In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?

Yes

No

In the last 12 months, were you ever hungry but didn’t eat because there wasn’t enough money for food?

Yes

No

In the last 12 months, did you lose weight because there wasn’t enough money for food?

Yes

No

In the last 12 months, did you ever not eat for a whole day because there wasn't enough money for food?

Yes

No

How often in the last 12 months did you ever not eat for a whole day because there wasn't enough money for food?

Almost every month

Some months but not every month

Only 1 or 2 months

Never

Experiencing food insecurity can negatively impact a person’s health, happiness, and wellbeing. Is there anything you would like to share about your experience with food insecurity that was not covered in the questions above?

Patron Demographics

What type of residence do you currently live in?

Off Campus Housing

Residence Hall or University Housing

Temporary Housing or Experiencing Homelessness

Are you currently employed?

Yes, I am employed by the university

Yes, I am employed outside of the university

Yes, I am employed by the university and by a different employer

No

Patron Reliance on Feed the Pack

Feed the Pack is designed to supplement the diets of our patrons. The pantry is not intended to fully feed our patrons. Feed the Pack is now part of the Pack Essentials Hub, a NC State department designed to connect students with basic needs support. This year, the Pack Essentials Hub will start inviting our partners to set up tables outside the pantry to connect our patrons with additional resources, such as the Supplemental Nutrition Assistance Program (SNAP) and other local food support programs. Your responses to the following questions will help us assess which partners would be most helpful to invite into our space. If you would like more information about the resources listed below, please visit https://feedthepack.dasa.ncsu.edu/resource-board/.

Which of the following resources are you currently using in addition to Feed the Pack?

SNAP Benefits (Supplemental Nutrition Assistance Program, Food Stamps, EBT)

WIC (Special Nutritional Assistance Program for Women, Infants, and Children)

Other local food banks

Pack Essentials Student Emergency Fund Applications

None of the Above

Which of the following resources are you aware of? Only select the resources that you know how to find eligibility information for or that you know how to access if you are eligible for them.

SNAP Benefits (Supplemental Nutrition Assistance Program, Food Stamps, EBT)

WIC (Special Nutritional Assistance Program for Women, Infants, and Children)

Student Health Services Nutrition Counseling