Name: _____________________________

All answers provided will be kept in confidential and never associated with your name.

1. What is your age?

1. Under 18 years
2. 18-24 years
3. 25-31 years
4. More than 31 years

2. What is your current education level?

1. Freshman
2. Sophomore
3. Junior
4. Senior

3. What is the best description of your race/ethnicity?

1. Hispanic or Latino
2. African American
3. Asian
4. White
5. Other

4. What is your gender?

1. Male
2. Female

5. What is your marital status?

1. Single
2. Married
3. Divorce/Separated
4. Widowed

6. What is your employment status?

1. Full-time
2. Part-time
3. Unemployed
4. Self-employed

7. What is your annual income?

1. Less than $20,000
2. $21,000-$40,000
3. $41,000-$60,000
4. Above $60,000

8. Do you live on campus?

1. Yes
2. No

9. What county do you reside in?

1. San Bernardino
2. Riverside

pg. 1
 3. Orange
4. Los Angeles

PRE SURVEY
1. Do you know what food insecurity means?
1. Yes
2. No

2. Were you worried that the food you eat would run out before you got money to buy more?
1. Yes
2. No

3. Can you afford to eat balanced meals regularly?

1. Yes
2. No
4. Did you have to reduce the size of your meals or skip meals entirely because there wasn’t enough money for
food?
1. Yes
2. No

5. Did you lose weight because there wasn’t enough money for food?
1. Yes
2. No

6. Do you have to travel more than 3 miles to get to a grocery store?

1. Yes
2. No

7. Are you uncomfortable discussing food shortage issues with your friends?
1. Yes
2. No

8. Do you know that CSUSB offers food through The DEN to students who may need it?
1. Yes
2. No

9. Would you utilize the CSUSB’s Food DEN if you needed food?
1. Yes
2. No

10. Are healthy foods easily accessible near your place of residence?
1. Yes
2. No

11. Do you believe food insecurity exists among CSUSB students?

1. Yes
2. No

13. Based on your answers, do you think you are food insecure?
1. Yes
2. No

pg. 2
Name:_____________________________
POST SURVEY

1. After watching the PSA, do you know what food insecurity means?
1. Yes
2. No

2. After watching the PSA, were you worried that the food would run out before you got money to buy more?
1. Yes
2. No

3. After watching the PSA, do you think you can afford to eat balanced meals?
1. Yes
2. No

4. After watching the PSA, do you remember a time when you had to reduce the size of your meals or skip meals
because there wasn’t enough money for food?
1. Yes
2. No

5. After watching the PSA, do you think you lost weight because there wasn’t enough money for food?
1. Yes
2. No

6. After watching the PSA, do you have to travel more than 3 miles to get to a grocery store?
1. Yes
2. No

7. After watching the PSA, are you still uncomfortable discussing food shortage issues with your friends?
1. Yes
2. No

8. After watching the PSA, do you now know that CSUSB offers food through The DEN to students who may need
it?
1. Yes
2. No

9. After watching the PSA, would you utilize the CSUSB’s Food DEN if you needed food support?
1. Yes
2. No

10. After watching the PSA, do you believe healthy foods are accessible near your residence?
1. Yes
2. No

11. After watching the PSA, do you believe food insecurity exists among CSUSB students?
1. Yes
2. No

pg. 3
12. After watching the PSA, do you consider yourself to be food insecure?

1. Yes
2. No

FEEDBACK SECTION

1. What do you think can be done to resolve food insecurity among the CSUSB students?
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________________________________________

2. Do you have any comments for our PSA with regards to food insecurity?
__________________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________

We are very appreciative of the time you have taken to complete this questionnaire. Your responses are essential
contributors to our research and serve as a platform for future research. Thanks to your contribution, we can help
fight against hunger!

pg. 4