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* 1. The demographics below are needed to represent you and your message to the Vatican statistically and anonymously in aggregate form. Depending on the volume of responses from your diocese, we may send data to your local bishop.

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* 2. Describe yourself based on the following:

  Gender Religious Status Catholic Standing Level of Satisfaction Age Range
My profile

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* 3. Please check the topics that you feel need reform in the Church.

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* 4. My present circumstance is best described as (check as many as fit your situation):

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* 5. From the pronouncements of Pope Francis, he suggests that all the faithful are called to active participation in teaching and governing, in mission and ministry. However, the current Church practice assumes that the faithful's only role is to listen while only the Church can teach. To what extent do you agree with the Church's current practice?

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* 6. I believe that all of the People of God – bishops, clergy, religious, lay men and women – by virtue of our baptism, should become part of a learning and teaching Church, discerning together what we have to do to bring the Gospel up to date and make Church teachings relevant for our times.

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* 7. If the teaching of the Church does not fit my values and experience, such as the Church's teaching on birth control, I believe I have a responsibility to allow my conscience to take precedence over the teaching.

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* 8. Despite the fact that many bishops are blocking the kind of dialogue Pope Francis is seeking, I believe that dialogue should become an institutional tool for building relationships to solve problems.

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* 9. To formulate valid Church teachings, the Church must responsibly listen to the faithful and honor their lived experiences.

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* 10. If the Church of the 21st century truly wants to understand the challenges and lived experiences facing families today, going along with Francis' call for dialogue, bishops must create opportunities for dialogue with all forms of families - divorced and remarried couples, same sex couples and families, couples in interfaith marriages, couples living together, and the like.

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* 11. Bishops must create systems and structures for dialogue within dioceses to discuss relevant social teachings that meet contemporary needs.

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* 12. Following the prompting of Pope Francis to open dialogue in dioceses, indicate which of the following dialogue venues already exist in your diocese:

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* 13. To acknowledge the lived reality of families today, the Church must include a broad spectrum of families (not just bishops and clerics) in the 2014 and 2015 Synod gatherings.

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* 14. The invitation for families to participate in the Synod should be the first stage of an ongoing exchange between bishops and the faithful on a wide range of contemporary issues.

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* 15. Share any personal experience, whether positive or negative, regarding any attempt you have made to reach out to your bishop or pastor regarding Church teaching or policy.
Note: Experiences will only be shared or represented as generalized experiences.

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* 16. If you have a comment not covered in this survey that you would like to add, please do so.

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