About this template
A family needs survey is an essential questionnaire used by social service agencies, charities, and community organizations to understand and address the specific requirements of families in their care. Whether you are coordinating emergency relief, distributing baby supplies, or connecting households with technology and mental health resources, this template streamlines the intake process.
Doc2Form allows you to instantly convert this template into a fully functioning Google Form, making it effortless to distribute via email, web links, or text message. Caseworkers and community coordinators can capture structured data on immediate supply needs, technology access, and resource enrollment without paper clutter.
By organizing responses directly in Google Sheets, your team can easily track assistance requests, identify widespread community trends, and coordinate timely support. Customize the questions to fit your organization's exact grant requirements or assistance programs in just a few clicks.
Key features
- Assess immediate household and supply needs instantly.
- Collect technology and internet access status for remote support.
- Track WIC and government program enrollment easily.
- Centralize all client responses in a secure Google Sheet.
- Fully customizable to match your agency's intake workflow.
Use cases
- Community outreach programs identifying household supply shortages.
- Nonprofit intake assessments for emergency assistance applicants.
- Social work case management and resource allocation tracking.
What this form collects
- Family Service Worker Name (Short answer)Enter the name of the caseworker or staff member assisting you.
- Child's Name (Short answer)Provide the full name of the child or primary dependent.
- Family Status Update (Paragraph)Briefly describe any recent changes in your household situation.
- Children Under 1 Status (Multiple choice)Are there any infants under the age of 1 in the household?
- Baby Food/Formula Used (Short answer)Specify the brands or types of baby food or formula currently needed.
- Baby Food/Formula Type Needed (Dropdown)Select the specific type required.
- Immediate Supply Needs (Checkboxes)Select any immediate supplies your family requires right now.
- Future Supply Needs (Paragraph)What supplies do you anticipate needing over the next month?
- Internet Access Status (Multiple choice)Describe your household's current internet connection.
- Laptop/Tablet Access Status (Multiple choice)Do you have working computers or tablets for family members?
- WIC Enrollment Status (Multiple choice)Are you currently enrolled in the WIC program?
- WIC Application Help Status (Multiple choice)Do you need assistance applying for WIC benefits?
- Immediate Essential Assistance Needs (Checkboxes)Select any urgent financial or living assistance required.
- Future Essential Assistance Needs (Paragraph)What long-term support might your family need in the coming months?
- Unemployment Application Help Status (Multiple choice)Do you require assistance filing for unemployment or job search support?
- Child Care Resources Needed Status (Multiple choice)Are you seeking information or placement for child care services?
- Mental Health Resources Needed Status (Multiple choice)Would your household benefit from counseling or mental health referrals?
- Preferred Email for Contact (Short answer)Enter the email address where our team can best reach you.
- Additional Help Request (Paragraph)Please share any other comments, questions, or specific requests you have for our agency.
FAQ
How do I share this survey with families?
Once Doc2Form generates your Google Form, you can share it via a direct link, email it to clients, or embed it directly on your organization's website.
Can I customize the questions on this template?
Yes! Because the template lives in your Google Drive as a standard Google Form, you can add, remove, or edit any questions to match your agency's specific grant or program requirements.
Where are survey responses stored?
All submissions go directly into your linked Google Sheet, allowing your team to review, sort, and analyze data securely in real time.
Is this template free to use?
Yes, Doc2Form lets you instantly convert this template into a Google Form at no cost.
Can caseworkers update responses on behalf of clients?
Yes, caseworkers can open the form and fill it out during phone consultations or in-person intake interviews to log information on behalf of the family.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.