Q01
Message
All templatesNonprofit & Civic
Community Service Gaps & Priorities Assessment
A structured needs assessment for local governments and nonprofits to identify residents' service priorities, access barriers, and communication preferences to guide resource allocation.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
23 questions · ~10 min
Q02
Multiple Choice
Which of the following community services have you personally used in the last 12 months? Select all that apply.
- Healthcare/clinics
- Mental health counseling
- Public transit
- Job training or employment services
- Childcare/early learning
- Housing assistance
- Parks/recreation programs
- Senior services
- Library or public internet
- Waste and recycling
- Public safety services (non-emergency)
- None of the above
- Other
Q03
Ranking
Please rank the following local issues by priority for the next 12 months. Drag to reorder (1 = highest priority).
- Affordable housing
- Public safety (non-emergency)
- Healthcare access
- Mental health and substance use support
- Jobs and skills training
- Childcare/early learning
- Public transit and mobility
Drag to rank
Q04
Multiple Choice
How would you prefer to hear about local services and events? Select all that apply.
- Text/SMS
- Email newsletters
- Local social media groups
- Posters/flyers in community spaces
- Community organizations/faith groups
- City or county website
- Local newspaper/radio
- Word of mouth
- Other
Q05
AI Interview
We'd like to understand your experience with community services in more depth. Please share what has worked well or what could be improved, and our moderator will ask a few follow-up questions.
Q06
Long Text
What is your ZIP or postal code?
Q07
Message
Thank you for completing the survey. Your responses are confidential and will help inform local planning and resource allocation. If you have questions about this study, please contact [organization name and contact information].
Q08
Multiple Choice
Do you voluntarily agree to participate in this survey?
- I agree to participate
- I do not agree
Q09
Opinion Scale
Overall, how satisfied were you with the community services you used in the last 12 months?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q10
Opinion Scale
How urgently do you feel local services need to change over the next 12 months?
Scale: 1 – 7
Min:Not at all urgentMax:Extremely urgent
Q11
Opinion Scale
In the last 12 months, how easy or difficult has it been to reach the right office or person when you needed help?
Scale: 1 – 7
Min:Very difficultMax:Very easy
Q12
Long Text
Based on your responses in this survey, is there anything else you would like to share about your community's needs or services?
Q13
Long Text
What is your neighborhood or nearest cross-streets? (optional)
Q14
Multiple Choice
Which best describes your connection to this community?
- I live here
- I don't live here, but I work or study here
- I do not live, work, or study here
Q15
Opinion Scale
Thinking about the last 12 months, how easy or difficult was it overall to access the community services you needed?
Scale: 1 – 7
Min:Very difficultMax:Very easy
Q16
Dropdown
About how long do you usually travel one-way to reach the community services you use most?
- Less than 10 minutes
- 10–19 minutes
- 20–29 minutes
- 30–44 minutes
- 45–59 minutes
- 60 minutes or more
- I don't travel to services (online/phone only)
- Not applicable
Q17
Dropdown
What is your age group?
- Under 18
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Q18
Multiple Choice
Which barriers have you personally faced when trying to use community services in the last 12 months? Select all that apply.
- Not aware of what's available
- Hours don't fit my schedule
- Transportation challenges
- Cost or fees
- Eligibility rules/documentation
- Language barriers
- Internet or device access
- Childcare responsibilities
- Physical accessibility
- Concerns about privacy or stigma
- Waitlists or delays
- Staff responsiveness
- Quality concerns
- None of the above
- Other
Q19
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q20
Dropdown
What is the highest level of education you have completed?
- Some high school or less
- High school diploma or GED
- Some college/associate degree
- Bachelor's degree
- Postgraduate or professional degree
- Prefer not to say
Q21
Multiple Choice
What is your current employment situation? Select all that apply.
- Employed full-time
- Employed part-time
- Self-employed
- Unemployed and looking
- Student
- Retired
- Homemaker/caregiver
- Unable to work
- Prefer not to say
Q22
Dropdown
Including yourself, how many people live in your household?
- 1 (just me)
- 2
- 3
- 4
- 5
- 6
- 7 or more
- Prefer not to say
Q23
Dropdown
How long have you lived in this community?
- Less than 6 months
- 6–12 months
- 1–3 years
- 3–5 years
- More than 5 years
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview question so residents can elaborate in their own words on service gaps, going beyond fixed-choice answers
- Combines quantitative opinion-scale questions (satisfaction, access difficulty, urgency, reaching officials) with a ranking exercise so priorities are directly comparable across respondents
- Captures access-barrier specifics (travel time, communication preferences, barriers faced) needed to guide equitable resource allocation, not just general satisfaction
- Ends with an open-text reflection question plus demographic/location fields, giving local governments both narrative context and segmentable data for reporting
SurveySparrow
Sample Community Needs Assessment Survey TemplateA printable, ready-to-use community needs assessment template covering typical service-use and satisfaction questions. It's built as a static question set rather than an adaptive interview, so all respondents see the same fixed items regardless of their answers. Useful as a quick-start form but not designed for deeper follow-up probing.
What it does well
- Printable format supports paper or in-person distribution alongside online use
- Pre-built question set saves setup time for a standard needs assessment
- Backed by a broader survey platform with reporting/dashboard features
Where it falls short
- No adaptive AI follow-up questioning to probe deeper into open-ended answers
- No automated per-response quality scoring of open text
- No voice AI interview option for residents who prefer speaking over typing
Typeform
Online Community Needs Assessment Survey TemplateA conversational, one-question-at-a-time survey template well suited to mobile completion and clean presentation. Logic can branch based on prior answers, but there is no AI-driven interviewing or automatic follow-up generation. Best suited to straightforward needs-assessment data collection rather than in-depth qualitative exploration.
What it does well
- Polished, mobile-friendly conversational UI that can improve completion rates
- Customizable branding and question flow
- Conditional logic to route respondents based on answers
Where it falls short
- No adaptive AI interview or automated follow-up probing on open responses
- No published methodology for how question logic or scoring works
- No built-in per-response quality scoring or auto-generated qualitative reports
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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