Community Needs Assessment Template

Community needs assessment survey template with 19 questions and 37 rating rows covering housing, local services, safety, transport, and health access.

Use this template

Copy this template into your account, then customize it to suit your needs.

This printable community needs assessment survey helps local governments, nonprofits, and neighborhood associations hear from every resident, including the many who never respond to online forms. It prints on about seven pages, with one clearly labeled section per page, and takes ten to fifteen minutes to complete.

What this survey measures

The survey opens with a short household profile, then works through the areas that shape daily life in a community: satisfaction with housing and its affordability, the importance of and satisfaction with eight core local services, safety and environmental conditions, transport and access around the area, and how easily residents can reach health and wellbeing services. A final section asks residents to pick their top priorities for the next five years, score the area as a place to live, and describe the biggest issue and the one change they most want to see.

How to use it on paper

Distribute copies at libraries, community centers, town halls, and public events, or mail them with a return envelope. Residents fill the checkboxes with a blue or black pen. Collect the completed forms and scan them in batches: PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results flow into your dashboard without manual data entry.

Customize this template

Add your city or organization logo, rename the services to match what your community actually provides, translate the form for multilingual outreach, or add questions about a specific project or budget decision. The paper layout reflows automatically as you edit, and every copy you print stays scannable.

Preview the PDF above, or use this template to start your community needs assessment today.

Questions in this template

  1. Your age group
  2. How many people live in your household, including you?
  3. How long have you lived in this area?
  4. Which best describes your housing situation?
  5. How satisfied are you with the following aspects of housing in this area?
  6. How affordable is housing in this area for someone on an average local income?
  7. How important is each of these services to you and your household?
  8. And how satisfied are you with each of these services today?
  9. Please tell us how much you agree with each statement.
  10. Which of the following are a concern in your neighborhood? Check all that apply.
  11. What is your main way of getting around the area?
  12. How often do you use public transit?
  13. How satisfied are you with the following?
  14. How easy is it for you to access each of the following?
  15. Which of the following make it harder for you to access health services? Check all that apply.
  16. Which areas should receive the most attention over the next five years? Choose up to three.
  17. How likely are you to recommend this area as a place to live?
  18. What is the single biggest issue facing this community today?
  19. What one change would most improve life in this community?

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