This paper describes the systematic approach utilized in the development of a survey instrument for use in a community assessment survey. The purpose behind the development of the survey instrument was to enable the Office of Research and Development at Central Florida Community College (CFCC) to determine by means of telephone interviews the perceptions of the community regarding the college, its operation, and its offerings. The survey instrument was also designed to assess the educational interests of the community. Procedures used to develop the survey instrument included a review of the literature to identify concepts essential to good questionnaire design, identification of specific questions and procedures for questionnaire construction used in other community surveys, input from local campus personnel, evaluation by an advisory committee, pilot-testing of the preliminary questionnaire and a retest to ascertain reliability of the instrument. As a result of the development process, a final questionnaire for use in a telephone survey was constructed. The final questionnaire, instructions for its use, tabulated data from the pilot test, and a bibliography are appended. (JDS)