Virginia WIC Participant Survey 2015

1. What is your age?  

• 12-15
• 16-21
• 22-25
• 26-30
• 31-40
• 41-50
• 51-60
• 61-79
• 80+

2. What is your highest level of education?

• Less than high school
• High School/GED
• Technical School
• Some College
• Associates Degree
• Bachelor Degree or higher

3. What is your race? (check all that apply)

• White/Caucasian
• Black/African American
• American Indian/Alaskan Native
• Asian
• Pacific Islander/Native Hawaiian
• Other

4. Are you? (check only one)

• Hispanic
• Non Hispanic

5. Check all categories of participants in your family:(Check all that apply)

• Infant less than 12 months
• Child 1 to 5 years old
• Pregnant woman
• Breastfeeding mother
• A new mom who feeds formula to baby

6. Which of the following WIC requirements is the hardest for you? (check only one)

• keeping appointments
• completing forms
• getting height, weight and blood work
• bringing proof of income
• bringing proof of residency
• bringing in children
• other
• none of the requirements are hard

7. How long did your last appointment take to complete? (check only one)

• less than 1/2 hour
• 1/2 hour to 1 hour
• 1 &1/2 hours
• 2 hours
• more than 2 hours

8. What foods do you find hardest to purchase or locate? (check all that apply)

• infant formula
• infant cereal
• infant baby food (fruits/vegetables/meats)
• juice
• milk
• lactose free/reduced milk
• soy milk
• cereal
• cheese
• eggs
• fruits and vegetables
• whole wheat bread
• fish
• legumes, dry beans
• peanut butter
• other

9. Do you purchase all of your WIC foods monthly?

• Yes
• No

If no, what is the main reason you did not purchase WIC foods? (check only one)

• unable to find in the store
• forgot
• check/vouchers expired
• did not need items
• unable to get to the store
• did not like or use foods on checks/vouchers
• other