FocusJr

Name

Telephone number

Address

City

State

Zip code

Email address

What is your job title or position?

Are you a Mother or Father of a child that lives in Atlanta?

Yes
No

What are the ages and gender of your children?

What are the main stores that you shop for groceries in Atlanta. Please give us the names of the MAIN stores you regularly shop for food for your family?

Please check the items below that you purchase for your child (ren) frequently or very frequently. Please ONLY SELECT the items you purchase frequently or very frequently.

Pre-made lunch boxes (such as Lunchables)
Granola or Energy bars
Snack packets ( e.g. pre-portioned packets of cookies, crackers, gummy fruits, etc..)
Apple sauce or fruit and veggie pouches (squeezable pouches of pureed fruits + veggies)
Juice boxes

How often does your child eat Pre-made lunch boxes (such as Lunchables)

Every day
At least twice a week
About once a week
Once or twice a month
Less than once a month
Does not eat lunch boxes

How often does your child eat Granola or Energy bars?

Every day
At least twice a week
About once a week
Once or twice a month
Less than once a month
Does not eat Granola or Energy Bars

How often does your child eat Snack Packets?

Every day
At least twice a week
About once a week
Once or twice a month
Less than once a month
Do not eat snack packets

How often does your child eat Apple sauce or fruit and veggie pouches of pureed fruits + veggies?

Every day
At least twice a week
About once a week
Once or twice a month
Less than once a month
Does not eat pouches of pureed fruits + veggies

How often does your child consume juice boxes?

Every day
At least twice a week
About once a week
Once or twice a month
Less than once a month
Does not consume juice boxes

For those whose child purchases Apple sauce or fruit and veggie pouches (squeezable pouches of pureed fruits + veggies) ONLY/ (others skip this question). Please check the brands that you purchase for Apple sauce or fruit and veggie pouches (squeezable pouches of pureed fruits + veggies)

Tree-Top
Mott’s
Go-Go Squeeze
Dole Fruitocracy
Musselman’s
Peter Rabbit Organics
Buddy Fruit
Any non-organic store brand
Other non-organic brand

Please tell us the brands of Apple sauce or fruit and veggie pouches (squeezable pouches of pureed fruits + veggies) that you purchase frequently or very frequently? If you do not purchase Apple sauce or fruit and veggie pouches (squeezable pouches of pureed fruits + veggies) then SKIP this question.

Please tell us the brand of juice boxes that you purchase frequently or very frequently? If you do not purchase juice boxs the skip this question.

Which of the following best descibes your ethnic background or how you most identify yorself?

African American
Caucasian/White
Asian
Hispanic/Latino
Native American
Bi-Racial
Other

Which of the following best describes your annual household income before taxes?

Under $25,000
$25,000-$34,999
$35,000-$49,999
$50,000K-$74,999
$75,000-$99,999
$100,000- $124,999
$125,000+

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