Northwestern University, Inc: Laoag City, Ilocos Norte

NORTHWESTERN UNIVERSITY, INC
Laoag City, Ilocos Norte
Name: __________________________________
Course & Section: ________________________
Facilitator: ______________________________
Activity 2: Community Needs Assessment Form
Direction: Interview your barangay officials in your respective barangay using the form.
Please observe health protocols during the said interview.
1. Name of Community /Institution Being Assessed:

________________________________________________________________
2. Venue or Description of the Location:

________________________________________________________________
3. Name of Community Leaders and Representative:

________________________________________________________________
________________________________________________________________
________________________________________________________________
4. Description of the Community and Basic Community Statistics:

________________________________________________________________
________________________________________________________________
________________________________________________________________
I. Community Leaders and Members’ Opinion
1. What activities are usually/currently conducted?

______ Social ______ Educational
______ Spiritual ______ Recreational
______ Livelihood ______ All of the above
______ Others, Please specify _________________________________________
2. How frequent are the activities being conducted?

____ Weekly ______ Semi- monthly
____ Monthly ______ Semi- annually
____ Annually
____Others, please specify: ____________________________________________
NSTP 2
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3. Who conduct the activities?

______ Barangay Council _______ Non-Government Organizations
______ Combination _______ Community/ Civic Groups
______ Youth/ Students
______ Others, Please specify: ________________________________________
4. Who are the active participants of the community being conducted?

______ Parents ______Mothers
______ Fathers ______ Youth
______ Students ______ Out of school youth
______ Kids
Others, please specify: _______________________________________________
5. Who benefits from the activities?

_____ Barangay Constituents
_____ NGO’s
Others, please specify: _______________________________________________
6. What are the facilities available in the community?

____ Library ________ Plaza
____ Sports center ________ Social hall
____ Day care center ________ Health Center
Others, please specify: ________________________________________________
7. Condition of roads:
_______ cemented ______ gravel and sand
_______ asphalted ______ muddy
_______ Dusty
8. What activities are perceived to be mostly needed by the community?

____ Livelihood activities ______ Job fair
____ Spiritual activities ______ Feeding program
____ Social mobilization
Others, please specify: __________________________________________________
9. Issues, problems and opportunities present in the community

_______ Family problem ______ Lack of support to activities
_______ Drug Addiction ______ Education
_______ Vices ______ Garbage
_______ Health ______ Peace and order
_______ Sanitation
NSTP 2
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10. Issues/concern that the community leaders/members think should be prioritized

_____ Cleanliness
_____ Peace and order
11. Barangay needs:

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12. Make an analysis or a narrative report based on the findings above together with
your documentation during the conduct of the said activities.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
NSTP 2
Page 3 of 3

Northwestern University, Inc: Laoag City, Ilocos Norte

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Northwestern University, Inc: Laoag City, Ilocos Norte

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NORTHWESTERN UNIVERSITY, INC

Laoag City, Ilocos Norte

Activity 2: Community Needs Assessment Form

1. Name of Community /Institution Being Assessed:

2. Venue or Description of the Location:

3. Name of Community Leaders and Representative:

4. Description of the Community and Basic Community Statistics:

I. Community Leaders and Members’ Opinion

1. What activities are usually/currently conducted?

2. How frequent are the activities being conducted?

3. Who conduct the activities?

4. Who are the active participants of the community being conducted?

5. Who benefits from the activities?

6. What are the facilities available in the community?

8. What activities are perceived to be mostly needed by the community?

9. Issues, problems and opportunities present in the community

10. Issues/concern that the community leaders/members think should be prioritized

11. Barangay needs:

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