Furniture Needs Assessment

Many families are in urgent need of replacement furniture to restore their living conditions. To address this, we are going to use this needs assessment to gather detailed information on the specific needs of our community. By doing so, we can effectively match furniture donations to those in need. Please fill out the assessment based on your specific requirements to ensure that the assistance provided meets your actual needs.

Question Title

* Provide your personal information below:

Name

Street Address

Town

Phone Number

Question Title

* Please select how many of the following furniture pieces your home requires:

	1	2	3	3	5
Adult Bed	Adult Bed 1	Adult Bed 2	Adult Bed 3	Adult Bed 3	Adult Bed 5
Child Bed	Child Bed 1	Child Bed 2	Child Bed 3	Child Bed 3	Child Bed 5
Crib	Crib 1	Crib 2	Crib 3	Crib 3	Crib 5
Dresser	Dresser 1	Dresser 2	Dresser 3	Dresser 3	Dresser 5
Night Stand	Night Stand 1	Night Stand 2	Night Stand 3	Night Stand 3	Night Stand 5
Dining Room Table	Dining Room Table 1	Dining Room Table 2	Dining Room Table 3	Dining Room Table 3	Dining Room Table 5
Dining Room Chairs	Dining Room Chairs 1	Dining Room Chairs 2	Dining Room Chairs 3	Dining Room Chairs 3	Dining Room Chairs 5
Couch	Couch 1	Couch 2	Couch 3	Couch 3	Couch 5
Chair	Chair 1	Chair 2	Chair 3	Chair 3	Chair 5
End Table	End Table 1	End Table 2	End Table 3	End Table 3	End Table 5
Coffee Table	Coffee Table 1	Coffee Table 2	Coffee Table 3	Coffee Table 3	Coffee Table 5
High Chair	High Chair 1	High Chair 2	High Chair 3	High Chair 3	High Chair 5
Desk	Desk 1	Desk 2	Desk 3	Desk 3	Desk 5
Office Chair	Office Chair 1	Office Chair 2	Office Chair 3	Office Chair 3	Office Chair 5

Other (please specify)

Question Title

* Does your household need the linen items below:

	Yes	No
King Bed Sheets	King Bed Sheets Yes	King Bed Sheets No
Queen Bed Sheets	Queen Bed Sheets Yes	Queen Bed Sheets No
Full Bed Sheets	Full Bed Sheets Yes	Full Bed Sheets No
Twin Bed Sheets	Twin Bed Sheets Yes	Twin Bed Sheets No
Crib Sheets	Crib Sheets Yes	Crib Sheets No
Bath Towels	Bath Towels Yes	Bath Towels No
Wash Cloths	Wash Cloths Yes	Wash Cloths No
Hand Towels	Hand Towels Yes	Hand Towels No

Other (please specify)

We will do our best to fill your furniture and linen requests, but are not able to make any guarantees. Furniture and linens are dependent on donations.