Community Needs Assessment Form
1. About You
Name (optional): __________________________
Age: _______ Gender: _______ Zip Code: __________
2. Community Strengths
What do you think are the biggest strengths of our community?
(Check all that apply)
Safe neighborhoods
Good schools
Access to healthcare
Community events
Supportive neighbors
Other: __________________________
3. Community Challenges
What are the biggest challenges or problems facing our community?
(Check all that apply)
Affordable housing
Job opportunities
Access to healthy food
Transportation
Childcare
Safety/crime
Healthcare access
Other: __________________________
4. Service Gaps
Are there any services or resources you feel are missing in our community?
Yes
No
If yes, please describe: __________________________
5. Priorities for Improvement
What should be the top priorities for improvement in our community?
(List up to three)
6. Barriers to Access
What makes it hard for you or others to access services or programs in our community?
(Check all that apply)
Lack of information
Transportation
Cost
Language barriers
Hours of operation
Technology access
Other: __________________________
7. Awareness & Use of Technology/AI in Nonprofits
Are you aware of any nonprofits in our community using technology or AI to help deliver services?
Yes
No
If yes, which ones and how? __________________________
Would you be interested in nonprofits using AI or automation to:
Send timely updates or reminders
Make it easier to sign up for programs or services
Provide quick answers to questions (chatbots, automated emails)
Personalize communications and outreach
Other: __________________________
What concerns, if any, do you have about nonprofits using AI or automation?
(Check all that apply)
Privacy of my data
Losing the “human touch”
Not understanding how it works
No concerns
Other: __________________________
8. Suggestions for Nonprofit Services & AI
What ideas do you have for how nonprofits could use technology or AI to better serve the community?
9. Willingness to Participate
Would you like to be involved in future discussions or planning about community needs and nonprofit services?
Yes
No
Maybe
10. Additional Comments
Please share any other thoughts or suggestions:
This form will help your nonprofit understand both the general and technology-related needs of your community, and gauge readiness and openness to AI automation as part of your service delivery