Community Needs Assessment Survey
We are a new grassroots organization and we're still in the process of piloting the services and resources we offer. We are looking for input from the community for ways to strengthen our efforts. Please let us know how we're doing and how we can better help you. Please remember that our programs are volunteer-run and require volunteers to offer additional hours, locations, or options. Please feel free to share as much or little as you'd like. Thank you for sharing your thoughts with us!
Sign in to Google to save your progress. Learn more
How did you hear about us?
Clear selection
What neighborhood do you live in?
Neighborhood name (optional: cross streets)
What subway stop(s) do you use most frequently?
i.e. at least once per week
How do you identify your gender?
Clear selection
How safe do you feel in your neighborhood--especially at night? (1 not safe to 5 very)
Not safe at all
Very safe
Clear selection
What do you need from public services (police, elected officials) to make you feel safer?
Improvements, services, etc.
What do you need from community-based organizations (like Safe Slope) to make you feel safer?
Improvements, services, etc.
Please tell us more about your thoughts about safety in your neighborhood
Have you used our Safe Walk program?
Clear selection
What other similar services have you used?
If you have thought about using a safe escort service but haven't, what were your reasons for not using the service?
For example, you felt like you had a short enough walk home, someone else might need the service more than you, you weren't sure how it worked
What steps have you taken to feel safer or more empowered?
For example, self-defense classes, walking with friends, etc.
If you HAVE used our Safe Walk program, what did you think?
Were we timely? Will you use us again? Were the hours convenient? Were the days convenient? Etc.
What days would you like Safe Walk to be offered?
Check all that apply
What days are MOST important for Safe Walk to be offered?
Pick 1 - 4 options
What WEEK NIGHT (Sunday night - Thursday night) hours would you prefer to have Safe Walk available?
What WEEKEND (Friday night  and Saturday night) hours would you prefer to have Safe Walk available?
Are you interested in taking self-defense classes?
Clear selection
Are you interested in attending workshops that address the roots of violence and/or violence prevention?
Clear selection
Is there anything else you'd like to share with us?
Optional: if you would like us to respond to/address your concerns, please provide your email address below
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.