Community Assessment Form

The Community Assessment Form is a vital tool for comprehending local needs and strengths. By gathering detailed insights into demographics, resources, and challenges, this form guides informed decision-making for targeted community development efforts. Your accurate input empowers us to create positive and impactful change.

Preferred Location^*

DOS ^*

Question	Answer
1. TRANSPORTATION ^*	YES NO
2. CHILDCARE ^*	YES NO
3. ADULT CARE ^*	YES NO
4. COMMUNITY & RECREATION ^*	YES NO
5. EDUCATION ^*	YES NO
6. EMERGENCY SERVICES ^*	YES NO
7. EMPLOYMENT ^*	YES NO
8. FAMILY SERVICES ^*	YES NO
9. FINANCIAL LEGAL ^*	YES NO
10. MEDICAL RESOURCES ^*	YES NO
11. RESIDENTIAL ^*	YES NO
12. FOOD & NUTRITION SERVICES ^*	YES NO
13. MENTAL HEALTH SERVICES ^*	YES NO
14. DISABILITY SUPPORT ^*	YES NO
15. VETERAN SERVICES ^*	YES NO
16. CULTURAL RESOURCES ^*	YES NO
17. ADDICTION RECOVERY ^*	YES NO
18. IMMIGRANT SERVICES ^*	YES NO
19. HOMELESS SERVICES ^*	YES NO
20. ENVIRONMENTAL SERVICES ^*	YES NO
21. HOUSING ASSISTANCE ^*	YES NO
22. LITERACY PROGRAMS ^*	YES NO
23. DOMESTIC VIOLENCE SUPPORT ^*	YES NO
24. COMMUNITY GARDENS ^*	YES NO
25. SKILL TRAINING & DEVELOPMENT ^*	YES NO

Please feel free to contact us today to schedule an appointment or to discuss our services in more detail.

Phone Number

(718) 395-6914

Email Address

[email protected]

Preferred Location^*

Name^*

Email ^*

Phone *

Contact Person

Patient

Insurance

Message^*

Jamaica

87-12 175th Street Unit #2A, Jamaica, New York 11432

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