Food & Health Needs Assessment
To support those from immigrant communities during the COVID pandemic, this assessment will help us to address to all those that have the most urgent food, health and social needs which require assistance.

The citizen initiative "United without Frontiers", which Portugal Multicultural Academy Association, Cooperativa BTUIN and other partners are a part of is working to identify those that are in need of help to mediate solutions and enable tailored support within this context. If you wish to be considered for it, please fill in all of the details within this assessment, which will take between 4 to 7 minutes to complete.
Data is shared anonymously within our partner organisations to ensure identity protection and facilitate personalised aid to your needs.

Note: if you fill this inquiry through your mobile phone, please do it in landscape mode (in horizontal).
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Email *
1.1. Name *
1.2. Contact Number *
(example: 00351_international code + 926486138_local contact number)
1.3. Age *
(example: 37)
1.4. Birthplace *
Place and Country (example: Lisbon, Portugal)
1.5. Nationality *
1.6. Languages spoken *
In the "Other" option, you can write other languages you're able to speak
Required
1.7. Gender *
1.8. Residence Address *
(example: Rua do Terreirinho, 77)
1.9. Concelho *
Name of the municipality (example: Lisboa)
1.10. Junta de Freguesia *
Name of the parish or borough (example: Santa Maria Maior)
1.11. Postal Code *
Put the whole 7 number digit without any hifen in between (example: 1100597)
1.12 How many household members live with you at this moment? *
Number of family members
1.13. How many of these household members that live with you have 10 years or less?
Please answer this question if you have said more than "0" to question 1.12. (optional)
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1.14. How did you get to know "United Without Frontiers" citizen initiative? *
1.15. What Social Media Network do you normally use? *
Required
1.16. Which is the best way to talk with you? *
Required
1.17. If you have another contact number for your Whatsapp or Imo account, please let us know
Please put your alternative contact number that is used in your account (example: 00351_international code + 926486138_local contact number)
1.18. Do you have a NISS number? *
This is your registration number with the Portuguese Social Security Services
1.19. NISS number
In case you answered "yes" to question 1.18., please fill this information so we can have provide you other ways of support (example: XXXXXXXXXXX, eleven digit number)
1.20. Do you need food relief and assistance? *
1.21. Do you need health support and/or medical assistance? *
1.22. Why are you requiring help? *
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