Community Survey Form

COMMUNITY SURVEY FORM

Name of Area Surveyed: ___________________________________________________

Person(s) Interviewed: _____________________________________________________

Address: ________________________________________________________________

Ask these questions:

1. What do you think are the needs in this community?

2. What do you feel a church can do to help meet these needs?

3. Can you give the name of a person living in the area who has a special need not

being met?

Name: ___________________________________ Need: _________________________

Address: ________________________________________________________________

Telephone: ______________________________________________________________

Person Conducting Survey: _________________________________________________

Telephone: ______________________________________________________________

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Parent category: Life