Refugee Status Assessment Survey
Please complete this survey to help us assess your current situation and needs as a refugee. Your responses will remain confidential and are used to provide appropriate support.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Country of Origin
*
Please Select
Syria
Afghanistan
Ukraine
Venezuela
South Sudan
Eritrea
Other
Current Country of Residence
*
Please Select
Turkey
Germany
United States
Greece
Lebanon
Other
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your current living situation?
*
Living in a camp
Living with relatives/friends
Rented accommodation
Homeless / No stable shelter
Other
Household Composition
Rows
Number of People
Age Group
Gender
Person 1
0-5
6-17
18-59
60+
Male
Female
Other
Person 2
0-5
6-17
18-59
60+
Male
Female
Other
Person 3
0-5
6-17
18-59
60+
Male
Female
Other
Person 4
0-5
6-17
18-59
60+
Male
Female
Other
Person 5
0-5
6-17
18-59
60+
Male
Female
Other
What are the main reasons for your displacement? (Select all that apply)
*
Armed conflict/war
Persecution (political, religious, etc.)
Natural disaster
Economic hardship
Other
How would you rate your current sense of safety and security?
*
Not safe at all
1
2
3
4
Completely safe
5
1 is Not safe at all, 5 is Completely safe
Which urgent needs do you currently have? (Select all that apply)
*
Food
Shelter
Medical care
Legal assistance
Employment
Education
Other
What is your current legal status in the country of residence?
*
Official refugee status granted
Asylum seeker (application pending)
No legal status
Other
What is your proficiency in the language of your current country of residence?
*
No proficiency
1
2
3
4
Fluent
5
1 is No proficiency, 5 is Fluent
Please provide any additional information or urgent concerns you wish to share.
Submit Assessment
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