Community Survey Form

Purpose: This survey aims to gather insights from local residents regarding the quality of community services, local concerns, and suggestions to improve the living standards in our neighborhood. Your participation is greatly valued and helps in effective decision-making for community development.

Participant Information

Full Name: {fullName}

Age: {age}

Gender: {gender}

Address: {address}

Email: {email}

Phone Number: {phoneNumber}

Survey Questions

1. How satisfied are you with the public services in your area?
   Response: {satisfactionPublicServices}
2. What are the most important issues affecting your neighborhood?
   Response: {keyIssues}
3. Have you participated in any local community events in the last year?
   Response: {communityEngagement}
4. In what areas would you like to see improvements?
   Response: {desiredImprovements}

{#$ additionalComments}

Additional Comments

{additionalComments}

{/}

Preferred Communication Methods

Please check all that apply:

{#contactMethods}

• {method}

{/contactMethods}

Household Members

Consent

{^hasGivenConsent}Participant has not given consent for follow-up contact.{/hasGivenConsent}

{#hasGivenConsent}Participant has given consent for follow-up contact.{/hasGivenConsent}

This form is confidential and will solely be used for community assessment purposes by authorized personnel.