7301 Germantown Avenue, Philadelphia, PA 19119
Contextual Education Office - The Rev. Dr. Charles R. Leonard, Director
CONGREGATIONAL DATA FORM
2014 - 2015 Academic Year
Name of Congregation or Organization: ______
Name of Pastor/Supervisor: ______
Church/ Organization Address:
______
______
Phone: ______FAX: ______
E-mail: ______
Supervisor’s Phone: ______
Church Website: ______
1. Have you or your congregation worked with seminary field education* students before? Yes____ No_____
Have you or your organization worked with seminary interns** before?
Yes_____ No_____
2. Church/organization staff: (Please include the total number per category)
Senior Pastor/CEO _____
Assistant/Associate Pastor _____
Associate In Ministry (AIM) _____
Director of Christian Education _____
Youth Director
Director of Music _____
Other Professional Staff _____
3. Membership:
Number of baptized ______
Number of confirmed ______
Average number of worshipers ______
CONGREGATIONAL DATA FORM
Percentage of congregation that is:
African American ____ Asian American _____ European American _____ Latina/Latino American _____ Other _____
Male_____ Female _____
Under 20_____ 21-40_____ 41-61_____ 62 and older______
4. Worship:
What hymnal(s) and/or worship book(s) are in use? ______
Would you describe the worship experience(s) in your congregation as -
(Check all that apply) Formal ___Informal ___ Contemporary ___ Other ___
How many Sunday Service(s) are held at the church? ______
How many Saturday Service(s) are held at the church? ______
Is your worship intentionally inclusive of other cultures and communities? Yes or No____
We seek to be inclusive of (check all that apply):
African Americans ___ European Americans ___ Latina/Latino Americans ___
German Americans ___ Asian Americans ___ Sexual Minorities ____
Hearing Impaired (signed services)___ Physically Challenged ____
Other (please explain) ______
5. Community: (Demographics of the community where your church/organization is located)
In what type of community is your church situated?
Urban - commercial _____
Urban - residential _____
Growing ___ Declining ___ Static ___
Suburban _____
First Ring Suburban ___ Second Ring Suburban ___ New Area ___
Small town _____
Rural _____
How would you describe the socio-economic and ethnic makeup of your community’s population? Predominantly
African American _____ Upper Class _____
Asian American _____ Middle Class/white collar _____
European American _____ Middle Class/blue collar _____
Latino/Latina American _____ Low Income _____
Mixed racial area _____ Mixed economic strata _____
Describe other important characteristics of your community:
______
CONGREGATIONAL DATA FORM
Does your congregation/organization reflect the demographics of your community?
Yes _____ No ______
If no, please explain: ______
5. Supervisor:
How long has the supervisor been ordained or held a position of leadership within the organization? ___
When was the last time you served as a supervisor to a seminarian? ___
Have you had any training in supervision? ___
How would you best describe your leadership style? Democratic ___ Authoritative ___ Collegial ___ Centered on the pastor ___ Congregationally centered ___
Centered on the development of leaders ____ Collaborative ___
6. Ministry:
What are the three strongest components (or programs) in the ministry of the church or organization?
1. ______
2. ______
3. ______
What are three components (or programs) of ministry that need development?
1. ______
2. ______
3. ______
The seminary has appointed specific areas of congregational/organizational life in which each field education student must engage. A listing of these activities will be provided. In addition, what activities would you want a field education student to participate in while assigned to your congregation?
Worship leadership _____
Visitation _____
Preaching _____
Education _____
Evangelism _____
Community outreach _____
Children _____
Youth _____
Women’s ministry _____
Men’s ministry _____
Social Ministry _____
Other Please explain ______
______
CONGREGATIONAL DATA FORM
7. Transportation:
Is your church/organization accessible by public transportation? Yes ___ No ___
Are you able to contribute to a student’s transportation costs? Yes ___ No ___
8. Other Information:\
Is the staff of your congregation/agency required to have criminal background checks?
Yes______No______
Have there been recent significant issues of conflict or misconduct in your congregation/agency?
Yes______No______
If yes, please explain.
Signature______Title______
Date:
· *A field education student can be defined as a seminary student who is assigned to a congregation or site for approximately 8-10 hours a week in a non-stipendiary position. The student will enter into an educational agreement with the organization. This agreement or educational covenant seeks to establish goals for learning while doing ministry during the course of an academic year.
· **An intern can be defined as a seminary student who works full-time for one academic year or half-time during two academic years in the context of a congregation. An intern receives a stipend, paid housing as well as other employee benefits. The intern will enter into an educational and service agreement with the congregation.
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