Sample Survey
Introduction
We need your help. We are interested in discovering how we can help those in our congregation struggling with medical or personal issues and need help. We intend to find ways to possibly help reduce your life’s challenges, not create new stressors.
Medical Accommodation Need
- Do you or any family member have a medical condition (physical, emotional, or mental) that makes it challenging to attend church-related activities? Yes No
- If you answered Yes, what type of difficulty do you have? (e.g., can’t hear, walking, etc.)
- Please describe what changes to the building, equipment, materials, etc., would help make it easier for you to participate in the worship service or church program offerings.
- If we provided the accommodation suggested above, would you be more likely to return to church, or would you still prefer to remain at home
Home Bound
- If you cannot attend in person, what would help you feel connected to others at church remotely?
- Can you connect to the internet if you cannot attend in person?
- Would you like to participate in group activities?
- Could you participate in group activities without someone replacing you at home?
Life Needs
Place a checkmark beside the areas of help you need.
- Assistance with vehicle maintenance
- Yard work
- House cleaning
- Food
- Meal preparation
- Clothing (Type and Sizes___
- Medical Supplies (What type)
- Transportation
- Respite for ½ day – day
- Home repairs
- Financial assistance (estimated amount_______)
- Furniture/equipment (describe____________)
- Legal Services
- Counseling Services
- Support group Type ______________
- Child Care
- Other needs
Formulating a Plan
After reviewing the survey data, you should better understand what your members need most. With that information, you can plan how to meet their needs. Let God show you how to design your program. Match talents to needs. Keep programs simple and appeal to your membership’s need to care for one another. Today, they care for a neighbor; tomorrow, the neighbor will care for them. Try to make it a church-wide program of caring for one another. Not only will you find rewards for the service given, but word will spread about the love within the church, and your membership will grow, too.
