Thank you for reaching out to us.
I am glad to hear you are actively taking into consideration the communities needs by engaging them! Unfortunately we do not have any template for this here.
It would be helpful to first identifying the beneficiaries that you would like to serve, research past projects implemented in the area for context, describe your organization (mission, success stories...) explaining to them the process and reasons for the survey (To have their valuable input...). Questions can relate about the challenges that the community is facing, the reasons behind these challenges, how can they be overcome, and the ideal vision they would like to see after the project is implemented/successful.
I realize that you already mentioned that you read some of our materials, however, this toolkit might help you: http://ctb.ku.edu/en/implement-social-marketing-effort
Good luck with your community engagement,
Let us know how it goes!