My Community Cares Needs Assessment
Step 1 of 2: Submit
Date
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Name
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Phone Number
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Email
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Address
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City
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Zip Code
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Date of Birth
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What is your gender?
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Male
Female
Other
What is your race/ethnicity?
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Who referred you to MCC?
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Please check the services you’re interested in below, and MCC will provide assistance to connect you with resources:
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Childcare and/or Child Support
Educational Support
Employment/Job Training
Financial Support and/or Public Benefits
Housing Assistance
Legal Services
Material Needs (ex: clothing, household supplies, etc.)
Intimate Partner Violence
Other
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indicates required fields