Tool 7: Annual Community Survey Starter Question Bank

Supports Habits 3 and 4 of Ten Habits of Great Grant Writers.

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A fillable version of this tool works right in your browser: open the interactive version. Add your own rows, columns, and items, then download, copy, or print your work. Nothing leaves your device.

Keep a consistent core so results compare year over year; add topical questions as needed. Adapt language to your community.

Who you are (consistent every year) 1. What is your relationship to [CONDITION / COMMUNITY]? (person with lived experience / parent or caregiver / family member / professional / other) 2. Where do you live? (US state or country) 3. How long have you been part of our community?

What you need (the two questions of Habit 4, asked directly) 4. What are the three biggest challenges facing you or your family right now? 5. Which of the following possible programs would you actually use? (list candidates, include "none of these") 6. What do you wish existed that no organization currently provides?

What exists (gap evidence) 7. Have you been offered [KEY SERVICE, e.g., genetic testing / care coordination / financial counseling]? (yes / no / not sure) 8. If yes, through whom? If no, what got in the way?

Engagement (your enrollment arithmetic, Habit 3) 9. Which of our programs or events did you participate in this year? 10. Would you consider joining [a registry / a study / a volunteer role]? (definitely / maybe / no)

Open door 11. What should we know that we did not ask?

Report the response count publicly every year; it becomes a capacity number.