Community Needs Assessment
The following questionnaire will only take a few minutes to complete and will be instrumental in identifying community needs, helping people, and improving services. Your personal information such as name and contact will be kept confidential. 

1.What is your role in the community? 
What is your role in the community? 
2.In which county do you live or represent?
In which county do you live or represent?
3.What is your gender?
What is your gender?
4.What is your age?
What is your age?
5.What is your race?
What is your race?
6.What is your ethnicity? 
What is your ethnicity? 
7.What is your education level? 
What is your education level? 
8.What is your military status?
What is your military status?
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