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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.
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1.
Contact Information:
(Required.)
Name
Organization
Title
Address
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Phone Number
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2.
Size of Organization:
(Required.)
Small (1-10 employees)
Medium (11-50 employees)
Large (51+ employees)
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3.
County of primary service: (Select all that apply)
(Required.)
Bucks
Montgomery
Philadelphia
Lehigh
Northampton
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4.
Primary Services Provided: (Select all that apply)
(Required.)
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:
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5.
Are these services primarily provided to low to moderate income individuals or distressed underserved individuals?
(Required.)
Yes
No
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6.
How many individuals does the organization serve yearly?
(Required.)