Community Needs Assessment

Who are you completing this as? *

County *

City / community

ZIP code

Age range (optional)

Household size (optional)

Employment status (optional)

Housing status (optional)

2. Priority needs

Select the areas that you believe need more attention, access, capacity, or coordination in this community.

3. Barriers to getting help

Overall, how easy is it to find and access needed services?

What is working well in this community that should be protected or expanded?

What service or resource gaps do you see?

If one practical improvement could be made first, what should it be?

4. Business, church, and partnership information

Business / employer: current hiring needs, skills gaps, or workforce barriers

Business / employer: partnership interest or resources you may be able to provide

Church / ministry: recurring needs you are seeing among people you serve

Church / ministry: partnership interest, outreach capacity, or resources

Request information about an HSM Back to Life Sunday-morning / church leadership presentation. Request a meeting with HSM Back to Life about community partnership opportunities.

5. Optional follow-up contact

You may submit the needs assessment without giving your name. Contact information is used only when you request or consent to follow-up.

Name / organization

Phone

HSM Back to Life may contact me about this submission or partnership opportunities.

Tell us what your community needs - and what is already working.

1. Perspective and location

2. Priority needs

3. Barriers to getting help

4. Business, church, and partnership information

5. Optional follow-up contact