The Lutheran Theological Seminary

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.