Survey - Connecting agencies to local produce - Greater Chicago Food Depository

Connecting agencies to local produce

Connecting our member agencies to community gardens

If your agency is interested in receiving produce donations from local gardens, please fill out the form below.

*1.

Question - Required - Agency Name:

(Maximum response 255 chars, approx. 5 rows of text)

*2.

Question - Required - Agency Number:

Question - Not Required - Program number (if applicable)

Contact information:

Name:

First Required	Last Required

Email: Required

Street 1: Required

City/State/ZIP:

City Required	State Required	ZIP Required

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*5.

Question - Required - Distribution Day(s):
Please make between 1 and 7 selections from the choices below.

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

*6.

Question - Required - What is your agency's capacity to receive additional produce (in pounds/containers) and with what frequency (ex. per month or per week)?

(Maximum response 255 chars, approx. 5 rows of text)

*7.

Question - Required - Is your agency able to weigh your food donations?

*8.

Question - Required - Is your agency able to pick up produce donations?

Question - Not Required - If you answered No to the above question, when are you/a representative from your organization available to receive produce donations?

(Maximum response 255 chars, approx. 5 rows of text)

*10.

Question - Required - Could a grower leave produce at the agency if no one is there to accept it?

*11.

Question - Required - Please provide a list of preferred produce and why.

*12.

Question - Required - Does produce need to be gleaned before you receive it?

*13.

Question - Required - Do you have requirements for the type of container used to store the produce?

14.

Question - Not Required - If you answered Yes to the above question, please tell us what types of container you use to store the produce.

(Maximum response 255 chars, approx. 5 rows of text)

*15.

Question - Required - Are there additional volunteer opportunities for gardeners at the pantry/agency?

*16.

Question - Required - Would your agency like to receive recipes, cooking tips, nutrition information, gardening tips or other supplemental information from donor gardens?

(Maximum response 255 chars, approx. 5 rows of text)

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