Community Needs Assessment Survey

Organizational Information

Thank you for taking the time to complete this survey. Your insights will help us better understand the anticipated needs and emerging trends in our community, so we can work together to address them effectively.

Question Title

* 1. Contact Information:

Name

Organization

Title

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Size of Organization:

Small (1-10 employees)

Medium (11-50 employees)

Large (51+ employees)

Question Title

* 3. County of primary service: (Select all that apply)

Bucks

Montgomery

Philadelphia

Lehigh

Northampton

Question Title

* 4. Primary Services Provided: (Select all that apply)

Affordable Housing and Homelessness Assistance

Financial, Utilities, and Food Assistance

Domestic Violence Shelter/Support

Workforce/ Business Development

Credit Counseling/ Financial Education

Youth programs

Healthcare Access

LGBTQIA+

Veterans

Individuals with Disabilities

Mental health/ Crisis Services

Drug and Alcohol Addiction

Immigration/ Refugee Support

Elder Support

Environmental Initiatives

Animal Welfare

Disaster Recovery

Other:

Question Title

* 5. Are these services primarily provided to low to moderate income individuals or distressed underserved individuals?

Yes

Community Needs Assessment Survey

Organizational Information

Question Title

* 1. Contact Information:

Question Title

* 2. Size of Organization:

Question Title

* 3. County of primary service: (Select all that apply)

Question Title

* 4. Primary Services Provided: (Select all that apply)

Question Title

* 5. Are these services primarily provided to low to moderate income individuals or distressed underserved individuals?

Question Title

* 6. How many individuals does the organization serve yearly?