City of Montclair Community Needs Assessment Survey

The City of Montclair would like your input on current community needs. The results of this assessment will assist us in future planning and help us better serve the Montclair community. ALL INFORMATION SUBMITTED WILL BE CONFIDENTIAL. Thank you for taking the time to assist us in continuing to offer effective services to our residents.

Please rank the following list of programs and services by level of importance, with "1" being "not important" and "5" being "most important".


Youth Education

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Adult Education

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Very Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Health

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Senior Services

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Child Care

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important


Youth & Teen Programs

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Case Management (Referrals and Linkage to the following services:)

Rate the level of importance for each of the following items and circle the one that best applies.

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important

Not Important Most Important


Comments And Suggestions:



Demographic Information

(This information will be kept confidential and used only for statistical purposes).








If you would like to be eligible for a gift valued at $25, please provide the following additional information.

City employees and their relatives, City Council members, Planning Commissioners and Community Action Committee members are not eligible (all information submitted will be confidential).




Powered by Google Docs Report Abuse - Terms of Service - Additional Terms