Community Needs Assessment

Strongly Disagree

Strongly Agree

Don't Know / Not Applicable

Drug abuse is a problem in my community.

Alcohol abuse is a problem in my community.

Crime is a problem in my community.

There is a need for after school care and learning for the children in this community.

There is a need for teaching English as a second language in this community.

Community Needs Assessment
Conducted by the New Hope Church of the Nazarene

The survey paper color is:

      White
      Blue
      Yellow
      Other color
      I didn't receive a paper survey

Please indicate your opinion to the following items for your community.

The biggest need this community has is:

I think the church should address the following needs in this community:

About Your Lifestyle

Household Structure:


	Number of Children living in home
	Number of adults age 19 to 64 living in home
	Number of adults age 65 and over living in home
	Total number of people living in my home

Church Attendance:

      I do not attend church.
      I attend church on special occasions like Easter and Christmas.
      I try to attend church at least monthly. Church Name:
      I try to attend church every week. Church name:

The music I like is: (Please choose up to 3)

      Rock
      Country
      Classical
      Pop
      R&B
      Gospel
      Jazz
      Rap
      Other:

Our Ministry to You

Please pray about the following concern I have:

Please send me a copy of the report from this Needs Assessment:

      No, thank you.
      Yes, send it to my e-mail:
      Yes, mail it to me at: (75 char)

Note: The above e-mail or mailing address will only be used to send a copy of the report -- never for any other purpose.

Please keep me informed about the happenings at the New Hope Church of the Nazarene:

      No, thank you.
      Yes, my e-mail address is:
      Yes, my mailing address is: (75 char)

100% Complete