Rapid Need Assessment
CARE Caucasus is conducting a rapid needs assessment of people from Ukraine, who had to flee violence in Ukraine and take shelter in Georgia. The survey will help CARE and its partners better respond to the needs of Ukrainians and plan our response. It will take 5-10minutes to fill in the survey.

Please note, that this form is not a registration for humanitarian support and there is no guarantee that the support will be provided. Nonetheless, CARE will get back to you if the survey reveals the vulnerability of you and/or your family and provide the support after verifying the information you have shared in the form.

Your participation is voluntary. We would like to ensure you, your answers will be completely anonymous and confidential, and, therefore, your name will not appear in our report. The information you provide will be only used to help us improve the services provided to the conflict-affected population in Georgia due to the war in Ukraine in the framework of humanitarian assistance regulations of Emergency Project for the Ukraine Crises response in Georgia
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1. Your age *
2. Your gender *
3. How many people are living with you? *
Please include yourself the total number of these people
3.1 among them boys age 0-5 (indicate how many)
3.2 among them girls age 0-5 (indicate how many)
3.3 among them boys age 6-18 (indicate how many)
3.4 among them girls age 6-18 (indicate how many)
3.5 among them men  19-56 (indicate how many)
3.6 among them women 19-56 (indicate how many)
3.7 among them men 56+ (indicate how many)
3.8 among them women 56+ (indicate how many)
3.9 among them pregnant or breastfeeding women (indicate how many)
3.10 among them people with disabilities (indicate how many)
4. When did you arrive to Georgia? *
MM
/
DD
/
YYYY
5. Do you expect that other family members of yours will be joining you in Georgia?
Clear selection
6.  Please specify, which accommodation type are you currently staying at? *
Other
7. Are you considering moving to another location/change accommodation within the next month?
Clear selection
Other
8. What are the top three priority need for you and your family members staying in Georgia?
First Priority
Second Priority
Thrird Priority
Food Items
Hygiene items
Clothes
Cash for various purposes
Psychological support
Temporary job/income generating opportunity
Legal support on registration
Accommodation/housing
Other (please specify
Other
9.  In the LAST 7 DAYS how often did you, individually, find yourself doing any of the following?
Very often
Often
Rare
Not Applicable
Eating less-preferred/expensive foods
Borrowing food or relying on help from friends and relatives
Limiting your intake in order for small children to eat
Limiting portion size at mealtime/number of meals per day
Clear selection
10. Please specify your sense of financial stability:
Clear selection
11. Please indicate whether you would like to receive more information to the following topics:
Yes, I would like to receive more information.
Sufficiently informed
Not relevant/interesting for me/my family
Access to medical services in Georgia
Access to school/kindergarden for my children
About accommodation/housing available in Georgia
Travel/transportation options in Georgia
Vaccination and COVID-19 prevention measures
Clear selection
12. Do you know hotlines in Georgia providing necessary information for people from Ukraine
Clear selection
13. Do you know whom to address/where to call in case of security concerns/Violence/harassments/abuse?
Clear selection
14. What are the main safety and dignity issues affecting you? *
Required
Other
15.  Please share any feedback about your needs/priorities/desires/concerns or support needed.
16. Please provide your contact information if you would like to received assistance from CARE. Contact details would remain with the CARE and will not be shared with anyone else without your permission.
Clear selection
Name and Surname:
Phone:
Email:
Address:
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