Lions Clubs International

Lions Community Needs Assessment

Questionnaire

Name of Resource Person: ____________________________________________________________________________________

Position:____________________________________________________________________________________________________

Address: ___________________________________________________________________________________________________

Business Telephone:_________________________________ Fax Number:___________________________________________

Area of Expertise:(please check one)

o Educational Services o Environmental Services o Youth Services

o Health Services o Social Services o Recreational Services

1. Can you identify specific community service projects in your field that you think are successful? o No o Yes

Please list ______________________________________________________________________________________________

_______________________________________________________________________________________________________

2. If you answered yes to question one, why do you think the community service projects you listed are successful?

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

3a. Can you identify specific needs in your field that, if met, would help service the community? o No o Yes

Please describe: ________________________________________________________________________________________

_______________________________________________________________________________________________________

3b. How do you think this need can best be met?_______________________________________________________________

_______________________________________________________________________________________________________

4a. Do you know of any duplication of efforts from volunteers in your service area? Are there two or more organizations

doing the same programs and fulfilling the same needs? o No o Yes

Please describe: ________________________________________________________________________________________

_______________________________________________________________________________________________________

4b. How can the groups work together to eliminate unnecessary duplication or coordinate joint efforts?

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

5. Do you feel that residents in this community are aware of the services and facilities offered? o No o Yes

Please comment: ________________________________________________________________________________________

_______________________________________________________________________________________________________

6. In your opinion, is there room for more volunteer involvement and programs in your service area? o No o Yes

Please comment: ________________________________________________________________________________________

_______________________________________________________________________________________________________

Additional Comments: ___________________________________________________________________________________

_______________________________________________________________________________________________________

Date:______________________ Return completed survey to:   

Jasper Lions Club

P.O. Box 403

Jasper, Alabama 35501

or email the answers to uabfan03@aol.com