Community Resource Survey Form

Community Resource Guide Survey

We would love your feedback! Please take a moment to fill out this survey. You will be entered to win a gift card good to a local business for filling it out! Note: We have a printed version of this guide we are working to distribute in our neighborhood with the help of volunteers. There is a electronic version on our website. Additionally, we are working to create a Spanish translation of the guide.

Overall usefulness of the resource guide*

Do you think the information in this guide is helpful?*

	1	2	3	4	5

1 is Not Very Helpful, 5 is Very Helpful

Did you learn of any new programs with this guide?*

YesNoMaybe
How can we improve the community resource guide?
Contact Information

For completing this survey you will be entered to win a gift card to a local business. Please provide your contact information so we connect with you if you win. Thank you!
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Community Resource Guide Survey