City Public Services Effectiveness Assessment Form
Help us improve your city by sharing your experiences and evaluations of public services.
Please provide your full name.
First Name
Last Name
What is your email address?
example@example.com
Which neighborhood or district do you reside in?
*
How long have you lived in this city?
*
Please Select
Less than 1 year
1-3 years
4-10 years
More than 10 years
Please rate the effectiveness of the following city public services:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Waste Management
1
2
3
4
5
Public Transportation
6
7
8
9
10
Road Maintenance
11
12
13
14
15
Public Parks & Recreation
16
17
18
19
20
Water Supply
21
22
23
24
25
Street Lighting
26
27
28
29
30
Public Safety (Police/Fire)
31
32
33
34
35
How satisfied are you with the cleanliness of public spaces in your area?
*
1
2
3
4
5
How would you rate the accessibility of city services for people with disabilities?
*
Not Accessible
1
2
3
4
Fully Accessible
5
1 is Not Accessible, 5 is Fully Accessible
Which public service do you believe needs the most improvement?
*
Waste Management
Public Transportation
Road Maintenance
Public Parks & Recreation
Water Supply
Street Lighting
Public Safety (Police/Fire)
Other
Please provide any suggestions or comments to help us improve city services.
Submit Assessment
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