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Fresh Bucks Waitlist Application
Application for Fresh Bucks Waitlist Application

Fresh Bucks Waitlist Application

Fresh Bucks helps Seattle residents afford fruits and vegetables.

12 of 14 Fresh Food Consumption

Required fields are marked with an asterisk ( * ).

During the past month, how often did you eat fruit?

Include fresh, frozen, or canned fruit. Do not include juices.

Never

1 time last month

2-3 times last month

1 time per week

2 times per week

3-4 times per week

5-6 times per week

1 time per day

2 or more times per day

Prefer not to answer

During the past month, how often did you eat a green leafy or lettuce salad, with or without other vegetables?

Never

1 time last month

2-3 times last month

1 time per week

2 times per week

3-4 times per week

5-6 times per week

1 time per day

2 or more times per day

Prefer not to answer

During the past month, how often did you eat any kind of fried potatoes, including French fries, home fries, or hash brown potatoes?

Never

1 time last month

2-3 times last month

1 time per week

2 times per week

3-4 times per week

5-6 times per week

1 time per day

2 or more times per day

Prefer not to answer

During the past month, how often did you eat any other kind of potatoes, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad?

Never

1 time last month

2-3 times last month

1 time per week

2 times per week

3-4 times per week

5-6 times per week

1 time per day

2 or more times per day

Prefer not to answer

During the past month, not including what you just told us about (green salads, potatoes), how often did you eat other vegetables?

Never

1 time last month

2-3 times last month

1 time per week

2 times per week

3-4 times per week

5-6 times per week

1 time per day

2 or more times per day

Prefer not to answer

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This page of your application either has some errors or some fields were left blank. If you continue to the previous page, none of the information entered on this page will be saved until the errors are corrected.