Date: First Name: Last Name:
Phone: Address:
City: State: Zip Code:
Age: Marital Status: Birthdate:



1. What special gifts, talents or personality traits do you bring to this ministry?
2. What is your educational background? List any special training such as Biblical studies or educational experiences.
3. Describe five things you have enjoyed doing most in your life from age five until now. Describe what you did well and what made you enjoy doing it. Describe each experience in a few sentences.
4. What are your strengths?
5. What are possible areas of weakness?
6. What personality types do you have difficulty working with?
7. How do you resolve conflict/disagreement?



1. How did you hear about our center?
2. What is your reason for getting involved in our center?
3. What other ministries or organizations have you been involved with?
4. How does your spouse/family feel about this involvement?
5. Have you ever counseled a woman who was considering an abortion or experienced an abortion yourself?
6. Have you ever known a single mother?
7. Under what circumstances, if any, would you consider an abortion as an alternative for a woman with a crisis pregnancy?
In cases of extreme psychological stress
Other(please explain below)
In cases of rape/incest
8. Knowledge of abortion risks: Knoedge of abortion laws:
9. List any books, films or other materials that you have read or viewed that relate to abortion.
10. How do you feel about a single woman parenting her baby?
11. How do you feel about a woman placing her baby for adoption?
12. Are you currently seeking adoption?
13. When do you feel sexual intercourse is morally permissible?
14. What are your feelings regarding birth control and teenagers and adults who are single and sexually active?




1. Do you consider yourself a Christian?
2. How long have you been a Christian? Please give a brief statement (testimony) about how you came to be a Christian.
3. How has your life changed since your personal relationship with Jesus Christ began?
4. What church do you attend?
5. How long have you been involved at your church?




Please list name of your Pastor and the names and addresses of two other people we may contact for references: