Community Needs Survey

Directions: Please consider each issue and rate its importance in the community. Place a number from 1 to 15 on the line next to the issue with #1 representing the most critical and #15 representing the least critical need to address in the community. You may add to the list, if you wish.

_____ Alcohol/drug use/drunk driving

_____ Community clean-up

_____ Homelessness

_____ Child abuse and or domestic violence

_____ Juvenile crime

_____ Teen pregnancy

_____ Adolescent suicide

_____ Shortage of after school/and or recreation programs

_____ Hunger

_____ Racial, ethnic, and/or gender discrimination

_____ Illiteracy

_____ Care for the elderly

_____ Improper health care/safety

_____ Transportation/road conditions

_____ Meeting the needs of the mentally or physically handicapped (including facilities like ramps, etc. and/or programs)