In The Name of Allah, The Most Merciful, The Most Kind

      Muslim Women's Help Network
          a subdivision of United Muslim Movement Against Homelessness/Helping Hands

v

Homelessness Survey


The purpose of this survey is to collect some of your observations about homelessness.   The United Muslim Movement Against Homelessness (U.M.M.A.H.) and the Muslims Women's Help Network (MWHN) are presently developing strategies aimed at serving the needs of the homeless, displaced, or those threatened with homelessness within the Islamic community.

To assist the need assessment for these efforts, we are requesting that Muslims and others with sincere interest in the plight of homelessness complete this brief survey. It should only take a few minutes of your time. Your honest sharing and input will be of benefit to the development of an improved support/delivery system, insha'Allah.

Please fill out the information as requested. Then at the end of the form supply your name and contact information should you so choose (optional), and submit the form. Thank you!


    Please select only one answer.

  1. Do you presently know any Muslim who is currently homeless?

    Yes       No        Don't know 

    2.   Do you know any Muslim who was homeless for any period of time within the past year?

          Yes       No        Don't know 

    3.    If you were aware of someone who was/is homeless, the circumstances were those of

          a male    a female    a family    a single-headed (female) family

    4.    Do you think that Muslims should help other Muslims who are homeless?

          Yes       No        Don't know

    5.    Do you think that non-Muslims should help Muslims who are homeless?

          Yes       No        Don't know 

    6.    Do you think that Muslims should help non-Muslims who are homeless?

          Yes       No        Don't know

    7.    Would you take an active role in helping the homeless?

          Yes       No         Don't know

   


    It would be helpful to know just a couple of things about you. Please answer the following:

    1.    What is your age?

	under 19   19-30     31-45     46+

    2.    What is your gender?

	Male     Female     

  1. Please enter any additional comments regarding this survey or your awareness of the impact of homelessness (optional):



        If you would like us to send you some literature about homelessness, please indicate your          mailing address?

        Name            
        Street            
        City               
        State                  Zip Code      

        Email:              


FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey.


Muslim Women's Help Network
United Muslim Movement Against Homelessness/Helping Hand
Revised: August 5, 2000