VisionOhio Preliminary Assessment

First Name*	Birth Year *	(e.g. 1958)
Last Name*	Gender *	Male Female
Mailing Address*	Marital Status*	Married Single (never married) Widowed Separated Divorced
City*
State/Province*
Zip/Postal Code*
Home Phone*	Have you ever led a church plant? *		Yes No
Work	Have you ever been part of a church plant?*		Yes No
Mobile	Have you ever served in full-time or part-time paid church ministry?*		Yes No
Email Address*	Are you presently active in a local church in your area?*		Yes No
Re-enter Email Address*
NOTE: Entering your email address twice helps to assure accuracy.
.
Denominational* Background
Education*
How did you learn about this assessment?*