About this template
The Food Insecurity Questionnaire is designed for social workers, community organizations, and healthcare providers to assess household and community food access challenges. This comprehensive survey template collects vital demographic data alongside standard indicators of food security, such as meal affordability, portion adjustments, and instances of skipping meals due to financial constraints.
Using Doc2Form, you can instantly turn this template into a live Google Form, making it easy to distribute via a link or QR code to families and individuals in need. The collected responses automatically populate a Google Sheet, allowing your team to analyze trends, generate reports, and allocate resources effectively. Whether you are running a community outreach program, a school support initiative, or a public health study, this questionnaire streamlines data collection while maintaining a respectful and clear format for respondents.
Key features
- Standardized food security and affordability assessment questions
- Built-in demographic tracking for comprehensive reporting
- Instant deployment via Google Forms with zero complex setup
- Automatic response organization in Google Sheets for easy analysis
- Accessible on all devices for community members and field staff
Use cases
- Community health and nutritional needs assessments
- Social work intake and household resource evaluations
- Nonprofit food pantry and assistance program eligibility
- Academic or public health research studies on hunger
What this form collects
- Full Name (Short answer)Optional. Enter your name if you would like follow-up assistance.
- Age (Short answer)Please enter your current age in years.
- State of Residence (Dropdown)Select the state where you currently reside.
- Education Level (Dropdown)Select the highest level of education completed.
- Employment Status (Dropdown)Choose the option that best describes your current employment situation.
- Did you ever run out of food in your house because you couldn't afford to buy more? (Multiple choice)Select the frequency that best applies to your household.
- Were you able to afford to eat healthy and nutritious meals? (Multiple choice)Reflecting on your typical grocery choices.
- Have you ever had to reduce the size of your meals because there wasn't enough money for food? (Multiple choice)Select the option that matches your experience.
- Did you ever eat less than you felt you should because there wasn't enough money for food? (Multiple choice)Consider instances where finances limited your food intake.
- Were you ever hungry but didn't eat because you couldn't afford enough food? (Multiple choice)Reflect on times when food supplies were critically low.
- Additional Comments or Support Needs (Paragraph)Please share any additional details or specific assistance your household may need at this time.
FAQ
How do I share this form with respondents?
Once generated in Google Forms, you can share the questionnaire via direct link, embed it on your organization's website, or print a QR code for in-person intake.
Where are the survey responses stored?
All submissions are stored securely in your Google Drive account and automatically organized in a linked Google Sheet for easy review.
Can I modify the questions to fit my program?
Yes! Because the template runs natively in Google Forms, you can easily add, edit, or remove questions to match your exact assessment criteria.
Is this questionnaire template free to use?
Yes, Doc2Form lets you convert this template into a Google Form completely free of charge.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.