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FOOD GROUPS — GRUPOS DE ALIMENTOS
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[av_contact_field label=’During the past week, did you eat foods from all 5 food groups each day? ¿Durante la última semana, comió usted alimentos de todos los 5 grupos de alimentos cada día?’ type=’select’ options=’Yes, No’ check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Within the next week, how often will you eat foods from all 5 food groups each day? ¿En la próxima semana, con qué frecuencia comerá usted alimentos de todos los 5 grupos de alimentos cada día?’ type=’select’ options=’Same as before/Lo mismo que antes, More often/Más que antes’ check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Please share with us how this class has helped you and your family, what you have learned and any healthy changes you plan to make/Por favor comparta con nosotros como esta clase le ayudará a usted y su familia:’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Data’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
Please Share a Little — Por favor, comparta un poco sobre usted.
We would like to learn about the people who attend our activities to help us improve our services. Your answers are combined with everyone else’s and cannot be used to identify you. Thank you for your help.
Con el fin de mejorar nuestros servicios, nos gustaría saber más acerca de las personas que asisten a nuestras actividades. Sus respuestas serán combinadas con todas las demás y no se usarán para identificarlo. Gracias por su ayuda.
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[av_contact_field label=’Age’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
1. Check the box that best describes your age — Marque la casilla que mejor describa su edad:
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[av_contact_field label=’0-4 years/años’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’5-17 years/años’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’18-59 years/años’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’60+ years/años’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Sex’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
2. Check the box that best describes your sex — Marque la casilla que mejor describa su sexo:
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[av_contact_field label=’Female/Mujer’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Male/Hombre’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Other/Otro’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Ethnicity’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
3. Check the box that best describes your ethnicity — Marque la casilla que mejor describa su etnia:
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[av_contact_field label=’Hispanic/Hispano/Latino’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’NOT Hispanic/Hispano/Latino’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Prefer not to say/Prefiero no decir’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Race’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
3. Check the box that best describes your race — Marque la casilla que mejor describa su raza:
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[av_contact_field label=’American Indian or Alaskan Native/Indígena de los EE. UU. o nativo de Alaska’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Asian/Asiático’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Black or African American/Negro o afroamericano’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’White/Blanco’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Native Hawaiian or Other Pacific Islander/Indígena hawaiano u otro isleño del Pacífico’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Prefer not to say/Prefiero no decir’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
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Funded by USDA SNAP, an equal opportunity provider and employer. Please visit www.CalFreshHealthyLiving.org for healthy tips.
Financiado por USDA SNAP (Programa de Asistencia Nutricional Suplementaria del Departamento de Agricultura de los Estados Unidos), una institución que es un proveedor y empleador que ofrece igualdad de oportunidades. Por favor, visite www.CalFreshHealthyLiving.org para información sobre la buena alimentación.
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