Community Impact Index Survey Form
Please complete this survey to help us understand your involvement and the impact you perceive in your local community.
How often do you participate in community events or activities?
*
Never
Rarely
Sometimes
Often
Very Often
Rate your overall sense of belonging in your community.
*
1
2
3
4
5
Which of the following best describes your role in community activities?
*
Participant
Volunteer
Organizer
Supporter
Other
How would you rate the impact of your contributions to the community?
*
No impact
1
2
3
4
Very high impact
5
1 is No impact, 5 is Very high impact
How aware are you of local community initiatives?
*
Not aware at all
Slightly aware
Moderately aware
Very aware
How satisfied are you with the following aspects of your community?
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Safety
1
2
3
4
5
Cleanliness
6
7
8
9
10
Access to resources
11
12
13
14
15
Opportunities for involvement
16
17
18
19
20
In the past year, how many hours per month have you dedicated to community service or volunteering?
*
Please Select
0 hours
1-5 hours
6-10 hours
11-20 hours
More than 20 hours
Which community issues are most important to you? (Select up to 3)
*
Public safety
Environment
Education
Health & wellness
Economic development
Other
How likely are you to recommend participating in local community activities to others?
*
Not likely at all
1
2
3
4
Extremely likely
5
1 is Not likely at all, 5 is Extremely likely
Please share any additional comments or suggestions about improving community impact.
Submit Survey
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