Grace Brethren North American Missions Church Planting Screening Assessment

Please complete the form below and click on "Continue to Assessment" when finished.
The fields marked with asterisks (*) are required.

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