Wufoo

Church Name *

Enter the name of your church. Make sure you identify your town if you enter "First Brethren Church."
Church ID Number *

This is the number printed at the top of the Statistical Report form you received in the mail from the Brethren Church National Office.
District
Name of Person Submitting Report *

Please type your first and last name with a single space separating the two.
Phone Number for Questions * ### - ### - ####
Your E-mail Address *
1. Last Year's Membership *

Please indicate the membership you reported last year as of December 31, 2010. This is on the Statistical Report form you received in the mail from the Brethren Church National Office.
2a. Membership gain through conversion

How many people joined your church this year through conversion?
This includes children, youth and adults.
2b. Membership gain through transfer

How many people joined your church this year through transfer from another church?
This includes children, youth and adults.
2. Total Membership Gain *

Total number of people that joined your church this year.
This is the total of 2a and 2b above.
3a. Memberhip Loss Through Transfer

How many people did you loss this year through transfer to another church?
3b. Membership Loss Because of Death

How many people did you loss this year because of the death of a member?
3. Membership Losses *

How many people did you lose from membership this year?
This is the total of 3a and 3b above.
4. Total Membership *

Total church membership as of December 31, 2010.
Formula: 1 + 2 - 3 = 4
5. Average Worship Attendance *

What was your average worship attendance?
6. Discipleship Ministry Involvement *

What percentage of your church attendance was involved in an intentional discipleship ministry each week?
(ie. small group, youth group, sunday school, etc.)
7. Financial Giving * $ Dollars . Cents
What was your total annual giving this year?
8. Conversions

How many people became followers of Jesus Christ through a connection with individuals in your fellowship this year?
(This number probably is not the same number as new members. This may require some discussion amongst church members to see how God has moved not only in the church last year, but also through the church in individual lives during this past year.)
Completion Process *
This report was mostly completed by one person, as listed at the top of this form. This report was mostly completed in a collaborative process with the input of other leaders

Please select the answer that best fits your situation.
Additional Information for Collaborative Process

If this was a collaborative process (choice #2), please enter the number of individuals directly involved in the process.
Relational

My local church is Relational.
Our church is characterized by individuals who are experiencing a deepening relationship with God and healthy, holistic relationships with others inside and outside the church. People in our church know how to work through differences of opinion and competing ideas in healthy ways that make the church stronger. We also, as a church, enjoy our relationship with our District and National Brethren Church.

Please indicate on the scale below which number best represents your assessment of your local church.
	Completely Disagree	Strongly Disagree	Disagree	Somewhat Disagree	Neutral (5)	Neutral (6)	Somewhat Agree	Agree	Strongly Agree	Completely Agree
Relational Statement	1	2	3	4	5	6	7	8	9	10

Comments

Please share examples of how you practice this value and provide anything you plan to du in the upcoming year to increase your church's health and/or effectiveness in this area.

Please do not use the "return" key while typing your response to this question. Thank you.
Missional

My local church is Missional.
Our church is intentionally facused on identifying and addressing the needs of people both in our community and around the world. We do this to improve lives now, and introduce them to the life-changing message of the Gospel.

Please indicate on the scale below which number best represents your assessment of your local church.
	Completely Disagree	Strongly Disagree	Disagree	Somewhat Disagree	Neutral (5)	Neutral (6)	Somewhat Agree	Agree	Strongly Agree	Completely Agree
Missional Statement	1	2	3	4	5	6	7	8	9	10

Comments

Please share examples of how you practice this value and provide anything you plan to du in the upcoming year to increase your church's health and/or effectiveness in this area.

Please don't use the "return" key while typing your response to this question. Thank you.
Sustainable

My local church is Sustainable.
Our church regularly identifies and develops new leaders and cares for their physical, emotional and spiritual needs. Our church is self-sustaining, fiscally sound, and follows good accounting and budgeting practices.

Please indicate on the scale below which number best represents your assessment of your local church.
	Completely Disagree	Strongly Disagree	Disagree	Somewhat Disagree	Neutral (5)	Neutral (6)	Somewhat Agree	Agree	Strongly Agree	Completely Agree
Sustainable Statement	1	2	3	4	5	6	7	8	9	10

Comments

Please share examples of how you practice this value and provide anything you plan to du in the upcoming year to increase your church's health and/or effectiveness in this area..
Please do not use the "return" key while typing your response to this question. Thank you.
Reproducing

My local church is Reproducing.
Our church is actively involved in the multiplication of healthy new disciples, leaders, ministries and churches.

Please indicate on the scale below which number best represents your assessment of your local church.
	Completely Disagree	Strongly Disagree	Disagree	Somewhat Disagree	Neutral (5)	Neutral (6)	Somewhat Agree	Agree	Strongly Agree	Completely Agree
Reproducing Statement	1	2	3	4	5	6	7	8	9	10

Comments

Please share examples of how you practice this value and provide anything you plan to du in the upcoming year to increase your church's health and/or effectiveness in this area.

Please do not use the "return" key while typing your response to this question. Thank you.
Global

Our church realizes there must be a balance between local and global ministry involvement. We actively strive for local, regional, national and global transformation.

Please indicate on the scale below which number best represents your assessment of your local church.
	Completely Disagree	Strongly Disagree	Disagree	Somewhat Disagree	Neutral (5)	Neutral (6)	Somewhat Agree	Agree	Strongly Agree	Completely Agree
Global Statement	1	2	3	4	5	6	7	8	9	10

Comments

Please share examples of how you practice this value and provide anything you plan to du in the upcoming year to increase your church's health and/or effectiveness in this area.

Please do not use the "return" key while typing your response to this question. Thank you.
Other Information

What other organizations does your congregation partner with throughout the year (Compassion International, Samaritan's Purse, etc.)?
Comments

Please do not use the "return" key while typing your response to this question. Thank you.
What additional training (books, seminars, conferences, etc.) has your congregation or individuals from your congregation taken advantage of?
Comments

Please do not use the "return" key while typing your response to this question. Thank you.
Has your church actively explored a missional relationship with one of your local schools? If yes, which one?
Comments

Please do not use the "return" key while typing your response to this question. Thank you.
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Wufoo

Relational

Missional

Sustainable

Reproducing

Global

Other Information