Instructions for Completing the EFNEP Survey
Form 793

Purpose of the survey: This survey is intended to measure changes in nutrition practices as a result of participation in EFNEP. It also serves as a way for the program assistant to determine where the participant needs the most help.

When the survey is to be completed: This survey should be taken every six months, once when the participant is enrolled (at the first or next meeting) and again six months later, or when they graduate, whichever comes first.

Who completes the survey: The survey can be completed by the paraprofessional when interviewing the participant or by the participant. Check to be sure that all questions are answered unless the information has not been taught. If a question does not apply, put n/a (not applicable) by the question.

After the survey is completed: The survey should be sent to the EFNEP agent on or before the next visit to the county Extension office. Each survey should be part of the participants family folder with the family record and the 24-hour food recall(s).

Note: Complete the survey every six months. However, only the first and last survey are entered in the computer. File any surveys taken between the first and final survey in the family record. Should the participant not complete a final survey, the most recent survey will serve as the final survey.

Directions:

1. Fill in the name of the participant, both first and last name. Use a middle initial if needed.

2. Fill in the date, which includes the day, month and year.

3. Leave the shaded area with ID# blank. This number will be assigned by the computer system when the family record is entered.

4. Check the box if the survey is the entry survey or the exit survey. If it is a six month survey, write six-month survey on the form.

5. Answer each question by putting  a check in the box under either, Do Not Do, Seldom, Sometimes, Most of the Time or Almost Always.

If you, the paraprofessional or volunteer, are completing the survey as part of the interview, read each question to the participant carefully. Repeat the question if necessary. If the participant needs an explanation or clarification, do so.