A survey of church and other needs

Dear friend...To help us better meet your spiritual needs, please fill in the following survey. As a token of our appreciation, we will send you a copy of the survey by e-mail once it is compiled.

What are your needs?

Please note that all fields followed by an asterisk must be filled in.

Do you go to church? *
Do you go to church? *

	Yes
	No

If Yes, Why? If No, why not? *
If Yes, Why? If No, why not? *

If anything, what could a church do to interest you in going?*
If anything, what could a church do to interest you in going?*

Do you have a home Church now? *
Do you have a home Church now? *

	Yes
	No

How often do you attend church?*
How often do you attend church?*

	Daily
	Weekly
	Monthly
	Only on Special Days/Holidays

How much do you believe in God? *
How much do you believe in God? *

Would you like to know God more? *
Would you like to know God more? *

	Yes
	No

Why / Why not? *
Why / Why not? *

Do you read the Bible?

	Yes
	No

If Yes, how often? *
If Yes, how often? *

	Daily
	Weekly
	Monthly
	Only on special occations

Do you Pray ?*
Do you Pray ?*

	Yes
	No

Why / Why not? and if yes, how often?*
Why / Why not? and if yes, how often?*

For Local Residents Only: Would you like to start a Sunday Bible Study, Prayer and Worship group in your location? *
For Local Residents Only: Would you like to start a Sunday Bible Study, Prayer and Worship group in your location? *

	Yes
	No

If yes (for Local Residents only) please leave your phone number. Only Local Residents will be called.*
If yes (for Local Residents only) please leave your phone number. Only Local Residents will be called.*

What are your 3 most pressing needs right now in your life (not necessarily spiritual)?*
What are your 3 most pressing needs right now in your life (not necessarily spiritual)?*

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

City*
City*

State/Prov*
State/Prov*

Country*
Country*

Please enter the word that you see below.

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