We'd love to hear your ideas for great family mealtimes. If we post your idea, we will use only your first name and state.

Because we are partially funded by US Department of Agriculture, it would be helpful for us if you would take a couple of minutes to answer the optional questions. All your answers will be confidential.

Please enter the following information:
Please note that items appearing in red are required in order to respond to any questions. First names only will be used to acknowledge your idea.  All other information is optional.  Thanks.

Name:
State/Province:

OPTIONAL:
Number of times you and your family eat dinner together in a week:

1-3
4-5
6
7 (every day)

OPTIONAL:
Number on children in your house by age
Number of children 1 to 4 years old
Number of children 5 to 12 years
Number of children 13 to 15 years
Number of children 16 to 18 years

OPTIONAL:
In the last year, have you or your family participated in any of the following food programs?  Select any or all that apply:

	WIC
	School Breakfast
	School Lunch
	Food Stamps
	Food Banks or Pantries
	Received nutrition information from Extension
	None