Faith and Health Coalition Assessment

Question Title

* 1. Congregational Contact Information:

Congregation Name

Address

Office phone

Office fax

Pastor(s) name

Pastor(s) email

Secretary name

Size: Avg. weekly attendance

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* 2. Does your faith organization have an active health ministry or committee?

Don't Know

No

Yes (Who serves on the committee?)

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* 3. Does your faith organization have a person appointed to be responsible for health related activities?

Don't Know

No

Yes (Who?)

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* 4. Has your faith organization ever established health or wellness goals for the faith community?

Don't Know

No

Yes

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* 5. Does your faith organization have a budget for health promotion or health related activities?

Don't Know

No

Yes

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* 6. Does your faith organization wish to start a health ministry or committee for your congregation?

Don't Know

No

Yes (Who should we contact about it)