Q01
Long Text
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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 · ~4 min
Q02
Multiple Choice
Which of the following community services have you personally used in the last 12 months? Select all that apply.
Q03
Long Text
Please rank the following local issues by priority for the next 12 months. Drag to reorder (1 = highest priority).
Q04
Multiple Choice
How would you prefer to hear about local services and events? Select all that apply.
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
Long Text
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?
Q09
Long Text
Overall, how satisfied were you with the community services you used in the last 12 months?
Q10
Long Text
How urgently do you feel local services need to change over the next 12 months?
Q11
Long Text
In the last 12 months, how easy or difficult has it been to reach the right office or person when you needed help?
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?
Q15
Long Text
Thinking about the last 12 months, how easy or difficult was it overall to access the community services you needed?
Q16
Long Text
About how long do you usually travel one-way to reach the community services you use most?
Q17
Long Text
What is your age group?
Q18
Multiple Choice
Which barriers have you personally faced when trying to use community services in the last 12 months? Select all that apply.
Q19
Multiple Choice
How do you describe your gender?
Q20
Long Text
What is the highest level of education you have completed?
Q21
Multiple Choice
What is your current employment situation? Select all that apply.
Q22
Long Text
Including yourself, how many people live in your household?
Q23
Long Text
How long have you lived in this community?
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.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.