If your kids are out of the home and/or have
grandkids (Answer this section even if you have
some kids at home, but at least one out of the
home.)
How has Faith at Home impacted you with your influence on your kids
and/or grandkids?
Greatly Somewhat
Slightly Not At All Explain your answer
How many times in the past two months have you talked with your kids
and/or grandkids about faith, spiritual life, the bible, etc.
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past two months have you sent an encouraging
card, email, text message or phone call to one of your kids and/or grandkids?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past two months have you prayed for the spiritual
life of your kids and/or grandkids?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past two months have you reached out to give
love, encouragement, support, guidance, and/or spiritual advice to one of
the parents or children in our congregation?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
What kind of spiritual impact do you want to have on your kids and/or
grandkids in the next year?
What is one area in your grown kid’s/grandkid’s spiritual life can you commit to
improving on? Be specific about your goal for the next 30 days, what, when, where,
and how will you grow?
Example: Email once a week words of encouragement to your grown kids. Tell
them you are praying for them.
Name:
Age: 20’s, 30’s, 40’s, 50’s, 60’s, 70’s+
Home status: Single, Mar r ied, Mar r ied w/ Childr en at home, Mar ried w/ Children out of the home, Widowed, Other____________
If your kids are still at home (Please answer)
I prioritize consistent family devotions, bible reading, prayer and/or worship time in my home.
Strongly Disagree
Please fill out the sections that apply to you then share your
results and goals with your spouse and a good friend.
Please share also with an elder or minister.
Personally (Everyone answer this section)
How has Faith At Home impacted your home this past year?
Greatly Somewhat
Slightly
Not At All Explain your answer-
I prioritize personal prayer, devotion, worship time in my schedule.
Strongly Disagree
Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Other than mealtimes and at church, how many times in the past week
have you prayed?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month have you read the Bible outside of
church?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month have you discussed the Bible or spiritual matters with someone outside of church?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month have you served or helped someone?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times this past year have you shared your faith with a NonChristian or invited a non-Christian to church?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
What is one area in your spiritual life can you commit to improving on?
Be specific about your goal for the next 30 days, what, when, where, and how will you
grow?
Example: Pray (Writing in a Journal) each morning before breakfast at 6:30am.
Example: Read the book of John this month, after dinner, in the quiet of my room.
Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
Agree
Strongly Agree
My home is a place where faith is nurtured.
Strongly Disagree
Disagree
Somewhat Disagree
Somewhat Agree
Other than mealtimes and at church, how many times in the past week
have I prayed aloud with any of my children?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past week has my family eaten a meal together
with television, music, and similar media turned off?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month have I read or discussed the Bible
with any of my children?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month have I discussed any biblical or spiritual matters with any of my children while engaging in day-to-day activities?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past two months has my family engaged in any
family devotional or worship time in our home?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past month has my family engaged in any type of
service project together?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
How many times in the past two months have I talked with my spouse or
close friend about my children’s spiritual development?
Never
Once
A Couple of Times
Three or Four Times
Five or Six Times
Seven or More Times
What is one area in your family’s spiritual life can you commit to improving on?
Be specific about your goal for the next 30 days, what, when, where, and how will you
grow?
Example: Read from a Kid’s Daily Devotional Book every night at the dinner table.