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Community Needs Assessment & Service Gaps Survey Template

Use our community needs assessment survey template to uncover priorities, access barriers, and service gaps. Edit questions and collect actionable data.

What's Included

AI-Powered Questions

Intelligent follow-up questions based on responses

Automated Analysis

Real-time sentiment and insight detection

Smart Distribution

Target the right audience automatically

Detailed Reports

Comprehensive insights and recommendations

Sample Survey Items

Q1
Multiple Choice
Please confirm you have read the description and voluntarily agree to participate.
  • I agree to participate
  • I do not agree
Q2
Multiple Choice
Do you currently live in this community?
  • Yes, I live here
  • No, but I work or study here
  • No, I do not live here
Q3
Ranking
Please rank the following local issues for the next 12 months (1 = highest priority).
Drag to order (top = most important)
  1. Affordable housing
  2. Public safety (non-emergency)
  3. Healthcare access
  4. Mental health and substance use support
  5. Jobs and skills training
  6. Childcare/early learning
  7. Public transit and mobility
Q4
Matrix
Thinking about the last 12 months, how easy or hard was it to access each service if you needed it?
RowsVery easyEasyNeither easy nor hardHardVery hardDid not need/try
Primary care/clinics••••••
Mental health counseling••••••
Public transit••••••
Affordable housing support••••••
Job placement/training••••••
Childcare programs••••••
Parks/recreation activities••••••
Q5
Opinion Scale
How urgent are improvements to local services over the next 12 months?
Range: 1 – 10
Min: Not urgentMid: Moderately urgentMax: Extremely urgent
Q6
Long Text
What one change would most improve daily life in your community?
Max 600 chars
Q7
Multiple Choice
Which of these have you 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
Q8
Rating
Overall, how satisfied were you with the community services you used in the last 12 months?
Scale: 10 (star)
Min: Very dissatisfiedMax: Very satisfied
Q9
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
Q10
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
Q11
Rating
How easy is it to reach the right office or person when you need help?
Scale: 10 (star)
Min: Very hardMax: Very easy
Q12
Numeric
About how many minutes do you usually travel one-way to reach the services you use most?
Accepts a numeric value
Whole numbers only
Q13
Multiple Choice
Quality check: To confirm you are paying attention, please select “Blue” below.
  • Red
  • Blue
  • Green
  • Yellow
Q14
Short Text
What is your ZIP/postal code?
Max 100 chars
Q15
Short Text
Neighborhood or nearest cross-streets (optional)
Max 100 chars
Q16
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
Q17
Multiple Choice
How do you describe your gender?
  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q18
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
Q19
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
Q20
Numeric
Including yourself, how many people live in your household?
Accepts a numeric value
Whole numbers only
Q21
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
Q22
Chat Message
Thanks for your time. Because you did not consent, you cannot continue. Please click Next to finish.
Q23
Chat Message
Thanks for your interest. This study is for residents. Please click Next to finish.
Q24
Short Text
You may leave this field blank and click Next to end the survey.
Max 100 chars
Q25
Long Text
Any other comments or suggestions you would like to share?
Max 600 chars
Q26
AI Interview
AI Interview: 2 Follow-up Questions on community needs and services
AI InterviewLength: 2Personality: Expert InterviewerMode: Fast
Q27
Chat Message
Thank you for completing the survey. Your responses will help inform local planning.

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