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Community Needs Assessment Template Form

Gather key insights to improve your community

Understanding the needs of your community can be challenging when you lack reliable data. This Community Needs Assessment Template helps you gather crucial information from residents, enabling effective decision-making for local improvements. With well-structured sections for personal data, household information, and employment details, you can prioritize community needs, identify gaps in services, and create meaningful change. Plus, the Unique ID widget streamlines submissions for easy tracking. Explore how this template can facilitate your assessment today.

What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
How do you describe your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
How many people live in your household, including you?
1
2
3
4
5 or more
Prefer not to say
What is your ZIP or postal code?
What language do you prefer for services?
Please Specify:
Which areas do you need help with right now?
Please Specify:
Which is your top priority right now?
Please Specify:
How urgent is your top need?
Today or within 48 hours
Within 1-2 weeks
Within a month
Not urgent
Prefer not to say
What makes it hard to get help, if anything?
Please Specify:
Overall, how satisfied are you with the support available in your community?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How often do you use community resources (e.g., food banks, clinics, libraries)?
Very rarely
Rarely
Sometimes
Often
Very often
Do you have health insurance or coverage?
Yes
No
What is your primary housing situation?
Own home
Renting
Living with family or friends temporarily
In shelter or transitional housing
Unhoused or without stable place to stay
Prefer not to say
In the past month, which best describes your access to food?
Enough of the kinds of food we want
Enough but not always the kinds we want
Sometimes not enough
Often not enough
Prefer not to say
How do you usually get around?
What internet or devices do you have regular access to?
Reliable home internet
Smartphone with data
Computer or tablet
Public Wi-Fi only
No internet access
Prefer not to say
Do you feel safe where you live?
Always
Often
Sometimes
Rarely
Never
Prefer not to say
Would you like help connecting to local services?
Yes
No
Your email address (optional)
Your phone number (optional)
Your name (optional)
Date (today)
Any other comments or needs you would like to share?
Do you allow us to share your information with trusted partner agencies to connect you to help?
Yes
No
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paper art illustration for community needs assessment template form showing various elements like checkboxes and charts

When to use this form

Use this form when you need clear input before choosing programs, budgets, or projects. It helps nonprofits, city departments, and neighborhood groups learn what residents need most. Run it before writing a grant, setting a capital plan, or launching services like food access, broadband, or transit. Ask residents what is urgent, what is missing, and where gaps exist. Use the results to set priorities, write goals, and track change over time. Once you spot the top issues, you can rally neighbors with a Community petition form or present your findings to officials with a Petition letter form.

Must Ask Community Needs Assessment Questions

  1. What are the top three issues your household faces right now?

    Prioritization yields ranked, comparable data instead of long wish lists. It directs limited funds toward the highest-impact problems.

  2. Where do these issues occur most, and how do they affect daily life?

    Location and impact detail help you target neighborhoods, routes, or facilities. This context improves scoping for projects and services.

  3. Which groups are most affected (for example, seniors, youth, renters, or disabled residents)?

    Identifying who is most affected guides equitable design and outreach. It prevents one-size-fits-all solutions that miss vulnerable people.

  4. Which services or resources are missing, and how often do you need them?

    Frequency and type reveal true service gaps and demand. That evidence supports timelines, staffing, and capacity planning.

  5. Would you support specific actions to address these needs, and if so, which ones?

    Action intent converts feedback into momentum you can organize. Respondents can opt to sign a coalition statement with a Sign-on letter form or mobilize workers using a Workplace petition form.

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