Community Assessment Form

The Community Assessment Form is an essential tool to know about the local needs and strengths of a local community. It provides a structured approach to collect essential data about demographics, available resources, and existing challenges. All these information helps NYCDocs to make informed decisions regarding targeted community health care development efforts.

Preferred Location^*

DOS ^*

Question	Answer
1. TRANSPORTATION ^*	YES NO
2. CHILDCARE ^*	YES NO
3. ADULT CARE ^*	YES NO
4. COMMUNITY & RECREATION ^*	YES NO
5. EDUCATION ^*	YES NO
6. EMERGENCY SERVICES ^*	YES NO
7. EMPLOYMENT ^*	YES NO
8. FAMILY SERVICES ^*	YES NO
9. FINANCIAL LEGAL ^*	YES NO
10. MEDICAL RESOURCES ^*	YES NO
11. RESIDENTIAL ^*	YES NO
12. FOOD & NUTRITION SERVICES ^*	YES NO
13. MENTAL HEALTH SERVICES ^*	YES NO
14. DISABILITY SUPPORT ^*	YES NO
15. VETERAN SERVICES ^*	YES NO
16. CULTURAL RESOURCES ^*	YES NO
17. ADDICTION RECOVERY ^*	YES NO
18. IMMIGRANT SERVICES ^*	YES NO
19. HOMELESS SERVICES ^*	YES NO
20. ENVIRONMENTAL SERVICES ^*	YES NO
21. HOUSING ASSISTANCE ^*	YES NO
22. LITERACY PROGRAMS ^*	YES NO
23. DOMESTIC VIOLENCE SUPPORT ^*	YES NO
24. COMMUNITY GARDENS ^*	YES NO
25. SKILL TRAINING & DEVELOPMENT ^*	YES NO

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