2026 Community Needs Assessment Form

We have to come together as a community and become a family to help each other survive in these uncertain times

Let’s meet to discuss today’s challenges and explore practical solutions together. Working as one community, we can create opportunities, share resources, and help one another build a stronger future

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2026 Community Needs Assessment *

• Consumer
• Active Senior (55+)
• Family Caregiver
• Small Business Owner
• Other

If Small Business Owner Selected – Enter Type of Small Business

If Other Selected – Enter Description

Ways to seek more information about our community powered support ecosystem:

• Schedule Consultation
• Request More Information
• Notify me of scheduled public venue meet up group activities

For Consultation Enter Area Code and Phone Number:

What is your Street Address?

What is your Apartment Number, if needed?

Please enter your 5-digit ZIP code *

Sign-Up For Available Founder Opportunities – Only 3 Slots Available for Each Category:

• Founding Member
• Founding Business Partner

Sign-Up For Future Founder Opportunities When Available:

• Future Founding Member
• Future Founding Business Partner

We welcome your questions, feedback, or just a friendly greeting.

What service interests you? (Check all that apply) *

• 55+ Check-In Program
• 55+ Social Activities & Events
• 55+ Tours & Travel Opportunities
• Business Assessment Tools
• Business Automation Solutions
• Business Concierge Coordination & Monitoring
• Business Google Profile (Optimized Lead Generation)
• Business Lead Generation
• Business Personal Assistance Coordination & Monitoring
• Business Process Documentation & Templates
• Business Upskill Training Opportunities
• Business Website Development
• Business Website Optimization
• Workshops & Educational Resources
• Business Resources
• Community Resources
• Emergency Disaster Inventory & Claims Support System
• Food & Grocery Delivery Coordination & Monitoring
• Home Repair Contractor Coordination & Monitoring
• Personal Assistance Coordination & Monitoring
• Personal Concierge Coordination & Monitoring
• Pre-Scam Review Service (Human Call Center)
• Professional Services Coordination & Monitoring
• Ride Share (Uber, Lyft, Ztrip) Coordination & Monitoring
• Specialty Transportation Coordination & Monitoring
• Upskill Training Opportunities
• Workshops & Educational Resources
• Other

If you selected the above option for "Other" enter additional information in the below box.

Of the above services which one service would you most likely use in the near future?

What problem would you like help with solving?

Tell me about who you are today, which best describes your current situation?

Tell me about where you want to be, which best describes the outcome that you're looking for from this product or service?

What's in the way, which best describes the reason you've not been able to get that outcome in the past?

What are you currently considering as an option for getting that outcome?

What is your age? *

• 18-24
• 25-34
• 35-44
• 45-54
• 55-64
• 65-74
• 75-80
• Above 80
• Prefer not to say

Race and ethnicity *

• African American
• Asian
• Native American
• White
• Other
• Prefer not to say

What is your highest qualification? *

• Less than high school
• High school/GED
• Associate degree
• Bachelor’s degree
• Graduate/Professional degree
• Prefer not to say

What is your marital status? *

• Married
• Divorced
• Separated
• Widowed
• Unmarried
• Prefer not to say

What is your current employment Status? *

• Full-time employment
• Part-time employment
• Unemployed
• Self-employed
• Homemaker
• Student
• Retired
• Prefer not to say

What is your approximate annual household income?

• Less than $65,000
• $65,000-$74,999
• $75,000-$89,999
• $90,000-$99,999
• $100,000-$124,999
• $125,000-$149,999
• $150,000-$199,999
• $200,000+
• Prefer not to say

What is your approximate annual business revenue?

• Less than $65,000
• $65,000-$74,999
• $75,000-$89,999
• $90,000-$99,999
• $100,000-$124,999
• $125,000-$149,999
• $150,000-$199,999
• $200,000
• Prefer not to say

How many people are currently living in your house? *

• 1
• 2
• 3
• 4
• 5+
• Prefer not to say

Do you currently own or rent your home? *

• I am a homeowner
• I am a renter
• I live with family or friends
• Other
• Prefer not to say

Do you have any mobility or accessibility needs we should consider when planning activities or services? *

• Yes
• No
• Prefer not to say

Are there any religious or cultural considerations that would affect your participation in community activities? *

• No
• Yes
• Prefer not to say

What Future Would

What is your primary language? *

• English
• Other

What other languages do you speak?

How did you hear about Community Bridge Solution? *

Would you like to receive occasional updates about Community Bridge Solution? *

• Yes, please send me quarterly email updates
• Yes, please notify me about new services and community opportunities
• No, thank you

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