SES Information Gathering Survey - Food Insecurity

Thank you for completing this form to help us learn more about student needs related to food insecurity.

Please select your school

Please select your school Bienen School of Music McCormick School of Engineering Medill School of Journalism School of Communication School of Education and Social Policy Weinberg College of Arts and Sciences
Class Year

Class Year 2022 2023 2024 2025 2026
Do you have any special affiliations?

Do you have any special affiliations? Quest Scholar Posse Scholar Ryan Scholar Gates Scholar Summer Program Alumni (Bridge, BioExcel, EXCEL, SAW, SLI) Other Other
Select your housing status:

Select your housing status: On-Campus Residence Hall/College/Community On-Campus Sorority/Fraternity House Off-Campus Commuter Student (living at home with family/guardian)
Do you have a campus meal plan?

Do you have a campus meal plan? Yes No

Please select what is most true for you in the last 30 days:
	Often True	Sometimes True	Never True
In the past 30 days, I worried whether my food would run out before I got money to buy more.	In the past 30 days, I worried whether my food would run out before I got money to buy more.Often True	In the past 30 days, I worried whether my food would run out before I got money to buy more.Sometimes True	In the past 30 days, I worried whether my food would run out before I got money to buy more.Never True
In the past 30 days, the food that I bought just didn't last, and I didn't have money to get more.	In the past 30 days, the food that I bought just didn't last, and I didn't have money to get more.Often True	In the past 30 days, the food that I bought just didn't last, and I didn't have money to get more.Sometimes True	In the past 30 days, the food that I bought just didn't last, and I didn't have money to get more.Never True
In the past 30 days, I couldn't afford to eat balanced meals.	In the past 30 days, I couldn't afford to eat balanced meals.Often True	In the past 30 days, I couldn't afford to eat balanced meals.Sometimes True	In the past 30 days, I couldn't afford to eat balanced meals.Never True

If you answered "often true" or "sometimes true" to the questions above, please complete the following section:

Please select what is most true for you in the last 30 days:
	Yes	No
In the past 30 days, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?	In the past 30 days, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?Yes	In the past 30 days, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?No
In the past 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?	In the past 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?Yes	In the past 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?No
In the past 30 days, were you ever hungry but didn't eat because there wasn't enough money for food?	In the past 30 days, were you ever hungry but didn't eat because there wasn't enough money for food?Yes	In the past 30 days, were you ever hungry but didn't eat because there wasn't enough money for food?No
In the past 30 days, did you lose weight beecause there wasn't enough money for food?	In the past 30 days, did you lose weight beecause there wasn't enough money for food?Yes	In the past 30 days, did you lose weight beecause there wasn't enough money for food?No

If you answered "yes" to any of the questions above, please complete the following section:
In the last 30 days, how many days did you ever cut the size of your meals or skip meals because there wasn't enough money for food?

In the last 30 days, how many days did you ever cut the size of your meals or skip meals because there wasn't enough money for food? 1-5 Days 5-10 Days 10-15 Days 15-20 Days 20+ Days
In the last 30 days, did you ever not eat for a whole day because there wasn't enough money for food?

In the last 30 days, did you ever not eat for a whole day because there wasn't enough money for food? Yes No If yes, how many days did this happen? If yes, how many days did this happen?
Student ID#
Name Name First Last
Would you like SES to follow-up with you for an individual appointment discuss financial resources for meals/food?

Would you like SES to follow-up with you for an individual appointment discuss financial resources for meals/food? Yes No Other Other
OPTIONAL: Provide your Northwestern email if you would like a member of the SES team to follow up with you.
Additional Comments: