MLI Single Mother's Survey
 Please answer ALL questions truthfully and in it's entirety. All information is confidential and is only used for statistic purposes within Mommy's Lounge Inspires and better ways of serving you.  Thanks! Management.
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Today's Date *
Are you a single Mother? *
How did you hear about Mommy's Lounge Inspires survey? *
Are you employed? *
How many children do you take care of full time that currently live with you? *
Please list the ages of the children that are currently living with you. *
If you answered yes to the above question please tell us if it's part time or full time. If no, place N/A. *
Are you currently in school/ College? If yes, Please list the school you attend. If no, place N/A. *
What is your Highest level of education? *
Race *
Select your age range *
Do you live with family or alone with children? *
Do you you rent or own your home? *
Do you live in Public housing? *
If you answered NO please list the area in which you live. (ex. Midfield, Ensley, Hoover etc.) *
If you answered yes please list the site location. ( ex. Gate City, Cooper green, Mattie Gill  Gardens etc. ) *
Do you receive assistance with utilities monthly? *
Do you receive child support? *
Are you disabled? *
Are you currently receiving any government assistance for yourself or children? Please select all that apply. *
Select the resource you need the most. *
Have you received assistance from MLI? If yes, was it beneficial? *
Have you received any assistance from MLI?  If yes, please rate your experience 1-5. 1 Being the least and 5 being the  greatest. If no, select other and type N/A *
MLI offers a Mom Support Group for all mothers. List a topic you would like to Incorporate and why. *
Do you feel a mom support group is needed for mothers? *
Would you recommend MLI to a friend or family member ? *
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