Skip to content
Mobile Community Action, Inc Comprehensive Needs Assessment 2020
1.
Which location did you visit for assistance, if any?
Administration/Main Office
Bayou La Batre
Citronelle
Hillsdale
Mount Vernon
Northside
Prichard/Plateau
South Brookley
South Mobile County
Washington County
Wilmer/Semmes
Home Visit
Outreach/Remote Site
N/A
2.
What is your zip code?
3.
Are any household members Disabled?
Yes
No
4.
Which best describes your current housing?
Own
Rent
Subsidized Rent - Section 8 or Public Housing or Based on Income
Living in Temporary/Transitional Housing
Homeless
5.
What is the range of your monthly rent/mortgage payment?
$100 or less
$101 to $500
$501 to $900
More than $901
6.
In general do you feel that you are financially
Better than one year ago
Worse than one year ago
About the same as one year ago
7.
This section is about the entire household. Add additional household members on the back of this page.
Age
Race
Sex
Education
Monthly Income
Source of Income
Health Insurance
Veteran
#1
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#2
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#3
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#4
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#5
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#6
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#7
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
#8
-- Select an option --
0-5
6-10
10-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
-- Select an option --
Black
White
Hispanic
Asian
Pacific Island
Multi Race
Native America
Other
-- Select an option --
male
female
other
-- Select an option --
youth 12th or less
did not attend school
Less than 9th grade
Did not graduate
GED
HS Diploma
HS + Some college
Associate Degree
Bachelors Degree
Masters Degree
Doctorate Degree
-- Select an option --
No Income Sources
0-900
901-1500
1501-2000
2001-2500
2501-3000
3001-3501
3501+
-- Select an option --
no income sources
pension
pt work
ft work
social security
disability
unemployment
child support
TANF
-- Select an option --
yes
no
-- Select an option --
yes
no
8.
Was the most recent time your first time requesting services from Mobile Community Action?
Yes
No
N/A
9.
Does your household Receive SNAP/Food Stamp benefits?
Yes
No
10.
Do you have any dependents age 0-5 attending the Early Head Start or Head Start Program?
Yes
No
11.
Are you currently employed?
Yes
No
12.
If no, how long have you been unemployed?
less than 1 month
less than 6 months
6 months or more
not employed seeking disability
N/A
13.
Are you currently in arrears on your housing (rent/mortgage) payment?
Yes
No
14.
Do you need consumer (credit/budget) counseling
Yes
No
15.
Do you need assistance with home repairs?
Yes
No
16.
Do you need assistance with your home heating/cooling costs?
Yes
No
17.
Do you have a General Education Diploma (GED) or high school diploma?
Yes
No
18.
If no, would you be interested in obtaining a GED?
Yes
No
N/A
19.
Do you need training or need to be retrained for a suitable job?
Yes
No
20.
What training do you seek?
21.
Do you usually have access to transportation?
Yes
No
22.
Please select all that apply to you.
Inability to find a job
Health Issues
Do not have high school diploma/GED
Difficulty managing money
Lack of job skills
Credit problems
Criminal record
Drug/alcohol abuse
Disability
Unaffordable housing
Affordable childcare
Unreliable/No transportation
23.
What do you feel may help you to reach your personal and/or professional goals?
Help finding a job
Reliable transportation
Job training classes
Complete GED
Help with resume
Reliable/affordable childcare
Other (please specify)
24.
What services have you or your family received in the last twelve (12) months from any organization or agency (mark all that apply)?
Utility Assistance
Rent, mortgage
Domestic violence shelter/assistance
Food
Disaster Relief
Transportation
Transitional housing
Health assistance (prescriptions)
Emergency Shelter
Did not receive services in the last year.
Other (please specify)
25.
Please list two (2) personal goals that you hope to accomplish in the next 12 months.
26.
List five needs in your community.
27.
Are you interested in volunteer opportunities with this agency? (If yes, please print your name and contact information below.
Yes
No
Other (please specify)
28.
Include any comments here:
