Name of Resource Person: ________________________________________________________________
Address: ______________________________________________________________________________
Business Phone: _________________________________Fax # ___________________________________
Area of Expertise (please check one):
___ Educational Services   ___  Environmental Services  ___ Youth Services
___ Health Services           ___ Social Services               ___Recreational Services

1. Can you identify specific community service projects in your field that you think are successful? 
Yes ___ No ___ Please list:

2. If you answered yes to question one, why do you think the community service progects you listed are successful?

3a. Can you think of specific needs in your field that, if met, would help service the community? Yes ___ No ___

3b. How do you think this need can best be met?

4a. Do you know of any duplication of efforts from volunteers in your service area? Are there two or more organizations doing the same programs and fulfilling the same needs? Yes ___ No ___

4b. How can the groups work together to eliminate unnecessary duplication or coordinate joint efforts?

5. Do you feel the residents in this community are aware of the services and facilities offered?  Yes ___ No ___
Please comment:

6. In your opinion, is there room for more volunteer involvement and programs in your service area? Yes ___ No ___
Please comment:

Additional comments:

Date: ______________________________

Please return the questionaire to: Potsdam Lions Club, P.O. Box 723, Potsdam, NY 13676
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