Community Needs Assessment

Community Needs Assessment — Form Fields

This surveys template includes 10 fields. Assess community priorities and needs for resource allocation, program planning, and public services improvement. Free to customize and use on ZenBuild.

• Neighborhood / Area (text, required)
• How long have you lived in this community? (dropdown selection, required) — options: Less than 1 year, 1–5 years, 5–10 years, 10–20 years, 20+ years / Lifelong
• What are the most pressing needs in your community? (checkboxes, required) — options: Affordable housing, Public transportation, Healthcare access, Job opportunities, Education & Schools, Public safety, Parks & Recreation, Mental health services, Childcare / Youth programs, Senior services — Select your top 3–5
• Overall quality of life in your community (rating, required) — 1 = Poor, 5 = Excellent
• Access to essential services (healthcare, groceries, transit) (rating, required) — 1 = Very limited, 5 = Excellent
• Safety and sense of security (rating, required) — 1 = Unsafe, 5 = Very safe
• What is one thing you'd change about your community? (long text, optional)
• What does your community do well? (long text, optional)
• Would you be willing to volunteer for community improvement efforts? (multiple choice, optional) — options: Yes, Maybe — depends on the time commitment, No
• Email Address (optional) (email, optional) — To receive updates on community initiatives