Emmaus Spirituality Center

Client and Prospective Client Survey

Please help us to ensure that the Emmaus Spirituality Center responds to your spiritual needs by answering the following questions. The survey will take only 5 minutes. We appreciate your assistance and promise that this information is confidential and solely for the use of creating programs. We will not contact you further unless you give us permission at the end of the survey. Thank You

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* 1. Contact

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Cell Phone Number

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* 2. Age

18-24

25-34

35-44

45-54

55-64

65-79

80+

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* 3. What is your gender?

Female

Male

description other

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* 4. Ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 5. Religious Tradition

Christian Catholic practicing

Christian Catholic non practicing

Christian Protestant

Christian Protestant practicing

Christian Protestant non practicing

Other

No religious tradition

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* 6. What religious or spiritual practices are most meaningful to you?

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* 7. When and in what way do you feel close to the Divine?

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* 8. What do you experience or hold to be sacred?

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* 9. Where do you go for spiritual development?

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* 10. What do you perceive as your greatest obstacle to spiritual development?

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* 11. Do you wish to be contacted with information regarding spiritual retreats and spiritual direction programs?

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* 12. What is your prefered contact method?

cell phone

text

mail