Needs Assessment Survey
Please take a few minutes to answer the following questions
What is your age range?
0-17
18-24
25-34
35-44
45-54
55-64
65+
We will be offering peer support groups in a variety of areas. Please check the groups you are most interested in. Check all that apply.
Teens
Parenting
Seniors
Marriage
Other
We are currently hosting a food distribution once a month. It is our hope to expand this service in order to reach more of those struggling with food insecurity. Please check all the areas that you feel would be of benefit.
Soup Kitchen style, weekly hot meal
A food rescue program to gather local produce, perishable items and then distribute.
Backpack program to send food home to school children over the weekend
Other
We are hoping to begin offering home repair. How needed do you feel this is?
Very needed
Somewhat needed
Not needed
Uncertain
Other
Please share your name
Email address
example@example.com
Please share any other thoughts or ideas. We want to hear from you!:
Submit
Should be Empty: