Please be completely open in sharing your perception of what is happening in church. All information will be kept in complete confidence.
In Christ's Service,
Rev. Peter Larsen
Director of Unity Ministry

1. Name of your Congregation:

2. Congregation's Location _____________, MI

3. Are you a member?
or Are you a non-member attendee?

4. How many years have you been attending?

5. Your age:
Select Age... Under 20 20-29 30-39 40-49 50-59 60-69 70-79 80+

6. How frequently do you attend services?
Select Attendance... Weekly 2-3 times per month Once a month Less than once per month

7. What do you see as your church's strengths?

8. What are its current challenges?

9. In terms of stress & intensity, choose your opinion of your churches emotional health:
1=Calm ... 7=Chaos Select Intensity ... 1 - Calm 2 3 4 5 6 7 - Chaos

10. Are there historical factors or repeating patterns which shed light on current tensions?

11. What positive changes would you suggest to help your church?

12. What else would you like to add to give understanding?