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Pre-Assessment Questionnaire
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General Information (Part 1/4)
Name
First
Last
Your Email
Phone
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Date of Birth
MM slash DD slash YYYY
Social Media Profiles
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Remove
Family Information (If Applicable)
Are you married?
(Required)
Yes
No
Spouse's Information
First
Last
Email
Phone
Date of Birth
MM slash DD slash YYYY
Occupation
Wedding Date
MM slash DD slash YYYY
Social Media Profiles
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Children (If Applicable)
Name
Age
Male/Female
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Please upload a family photo
Accepted file types: jpg, jpeg, png, gif.
Questionnaire
In what role do you see yourself as you seek to establish a new church? Will this be a paid role?
How did you hear about or who referred you to Evergreen Assessment?
References
Please provide names, emails, and phone numbers for at least four references of people who know you well.
Reference #1
Name
First
Last
Email
Phone
Reference #2
Name
First
Last
Email
Phone
Reference #3
Name
First
Last
Email
Phone
Reference #4
Name
First
Last
Email
Phone
Additional References
Church Planting and Ministry Journey (Part 2/4)
In this section, consider the journey that is leading you to church planting, reflect on how this journey has been affirmed in your life, and indicate what experiences have prepared you for this calling.
Why are you (and your spouse, if married) interested in establishing a new church?
Describe how Scripture, prayer, and/or other followers of Jesus have affirmed this direction in your life.
Have you ever been a part of starting a new church before?
Yes
No
What was your role?
Describe the model or strategy of that new church.
Please provide the name of that new church.
Please provide the website of that new church.
Describe the attitude of your immediate and extended family towards the idea of you leading in the establishment of a new church. If you are married, how deeply have you and your spouse communicated about what this will mean for you as a couple and as a family? Are you in agreement?
Have you ever been dismissed from a ministry position?
Yes
No
Please explain.
Reflect on the most serious problem you have faced in your ministry. What did you learn from this problem that is informing how you hope to lead in the next ministry position?
Reflect on your formal ministry experience. What roles did you hold or serve in? How did that work shape you personally and how did it shape your desire for starting a new church?
Reflect on any formal education you have and how that has prepared you to start a new church. What schools did you attend, what classes did you excel in, and how did your education shape you as a person and the skills you bring to the church planting journey?
Do you see yourself as being the primary communicator for this new church?
Yes
No
Please provide links to at least three videos of you speaking in the last year:
Where do you feel you may be called to establish a new church? Please be as specific as you are able to be.
What is the cultural makeup of this area? (Ethnic, demographic, economic mix, style of living, size, etc.) What is drawing you to start a new church in that area?
Are you tied to a particular timeline? If so, what are the factors that are driving the dates and what are those dates? (e.g., leaving your current employment, launch day, start of school, etc.)
What expression or church planting model do you envision? (Micro, home based, larger gathering, don’t know, etc.)
Describe what success would look like at the end of year 1, 2 and 5.
What will the role of women be in your new church?
Evergreen Network holds a theologically traditional sexual ethic when it comes to marriage and sexuality. How would you describe your own theology related to marriage and sexual expression?
Personal and Marriage Background (Part 3/4)
In this section consider how God has formed you and your family for church planting. What influences have shaped you? What are your strengths? What are you working to improve?
How did you come to a personal faith in Christ?
What are your personal habits of prayer, devotional Bible study, or other spiritual disciplines that you find helpful in your spiritual growth?
Describe a time when you had a crisis of faith.
How would others describe your personality?
How do you handle conflict? Please describe a recent incident.
How do you spend your free time? List any hobbies and special interests.
Describe your current physical/mental health status:
Do you have any addictions or problems with drugs, alcohol or pornography?
Yes
No
Please explain:
What do you consider to be your greatest strengths?
What are the areas where you need the greatest improvement?
Have you ever been widowed?
Yes
No
Please explain:
Have you ever been divorced?
Yes
No
Please explain:
How would you describe your marriage? Give specific behavioral examples of how you and your spouse relate to one another:
How do you and your spouse communicate?
Have you ever been unfaithful to one another in your sexual relationship (for this relationship or a previous one)?
Yes
No
Please explain:
Finance and Stewardship (Part 4/4)
In this section explore your personal financial situation and also your experience with raising funds. Both will directly influence your church planting journey.
Describe your current household financial situation:
Do you operate from a household budget?
Yes
No
Please describe:
Do you give away 10% or more of your gross income?
Yes
No
What was your approximate giving last year?
Please explain:
What is your total indebtedness? Please be specific.
Mortgage Debt:
School Loans:
Other:
How did your family (both growing up and as an adult) view money? How does this perspective inform how you currently view money?
How do you plan to pursue financial sustainability for your new church plant? What sources do you plan on utilizing to help your church become healthy and multiply?
Have you ever raised financial resources specifically to fund ministry? If so, reflect on that experience. How much did you raise? What was the project? What challenged you most? Where did you excel in raising funds?
Are you (and your spouse) prepared to raise funds to establish a new church? How would you go about doing that? What ideas or strategies have you considered? Have you begun to explore other churches, organizations, and individuals in your circle of influence that would be willing to support your vision?
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