Vital Impact Assessment: North Clinton

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1. Approximately how many years have you attended this church?

 Less than a year

 1-2 years

 3-5 years

 6-10 years

 11-20 years

 21 years or more

 I do not attend this church

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2. Approximately how many years have you been a Christian?

 Less than a year

 1-2 years

 3-5 years

 6-10 years

 11-20 years

 21 years or more

 I am not a Christian

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3. Age

 18 or younger

 19- 29

 30-45

 46-54

 55-70

71 or older

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4. Gender

 Male

 Female

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5. Current marital status

 Single

 Married

 Divorced or separated

 Widowed

 Cohabitating

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6. How many children do you have?

 0

 1

 2

 3-5

 6 or more

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7. How often do you read the Bible? (0: No answer, 1: Never, 5: Occasionally, 10: Daily)

0

5

10

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8. How often do you meet with a person or small group for Christian discipleship? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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9. How often do you talk about God in daily conversations? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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10. How often do you sense a close connection to the Holy Spirit? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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11. How often do you intentionally disciple your child(ren) in the Christian faith? (0: N/A, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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12. How often do you talk about your Christian faith with unbelievers? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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13. How often do you invite someone to church who does not attend? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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14. How often do you volunteer to help with church services and events? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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15. How often do you engage in acts of service outside of church events? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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16. How generous are you in giving away your income to God's kingdom priorities? (0: No answer, 1: No giving, 5: Mod. level of giving [5% of annual income], 10: High level of giving [10%+ of annual income])

0

5

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17. How often do you engage in harmful or addictive behaviors? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

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18. How often do you feel depressed? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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19. How often do you feel overwhelming anxiety? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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20. How often do you feel a lack of personal significance? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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21. How often do you worry that you don't have enough money for basic necessities? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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22. I have a strong support network (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

10

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23. People would say I resolve conflict in a Christlike manner (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

10

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24. How strong was your relationship with God 5 years ago? (0: No answer, 1: No relationship, 10: Very strong relationship)

0

5

10

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25. How strong is your relationship with God now? (0: No answer, 1: No relationship, 10: Very strong relationship)

0

5

10

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26. The Bible is the Word of God and is fully reliable and trustworthy for Christian faith and life (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

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27. I fully believe in our church's statement of faith (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

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28. The local church's primary mission is to go and make disciples of those who do not believe. (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

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29. I am excited about our church's future. (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

10

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30. How often do you attend church services? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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31. How often do you attend a small group or Sunday school? (0: No answer, 1: Never, 5: Occasionally, 10: Frequently)

0

5

10

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32. Our church is making an impact in our community (0: No answer, 1: Strongly disagree, 10: Strongly agree)

0

5

10

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33. What level of participation do you have right now? (0: No answer, 1: No participation, 10: Very high participation)

0

5

10

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34. What level of participation do you expect to have in the near future? (0: No answer, 1: No participation, 10: Very high participation)

0

5

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35. What is your greatest hope for the church moving forward?

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36. Ethnicity or Race

 Asian/Pacific Islander

 Black or African American

 Hispanic or Latino

 Native American

 White Non-Hispanic

 Other/Choose not to say

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37. Highest education level

 Less than High School Diploma

 High School Diploma

 Some College or Post-Secondary Education

 Associate’s degree or Equivalent

 Bachelor’s Degree or Equivalent

 Master’s or Ph. D.

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38. Annual household income

 Less than $14,999

 $15,000 - $29,999

 $30,000 - $49,000

 $50,000 - $69,000

 $70,000 - $99,999

 $100,000 - $149,999

 $150,000 or more

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39. Did you become a Christian through a ministry of this church?

 Definitely yes

 Probably yes

 Might or might not

 Probably not

 Definitely not

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40. Do any of the following activities regularly impact your church attendance?

Work

Personal travel (e.g., vacation)

Children's sports or hobbies

Work travel

Other (please specify)

None of the above

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41. What do you sense God calling our church to focus on in the next year?

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42. Anything else you'd like to share about our church?

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