TLM Outreach Contact Form
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name of Individual
*
Street Address
*City, State, and Zip not required
Tel No.:
DISCUSSION INCLUDED:
Rows
Yes
No
N/A
Church/Service Invitation
4 Spiritual Laws
Prayer
Encouragement
Bible Study Invitation
Intercessory Prayer Invitation
SERVICE(S) OF INTEREST
Rows
Yes
No
N/A
Grocery Assistance/Food Services
Housing Assistance (Unhoused)
Gas Assistance
Resume Services
Computer Literacy Training
Gift(s) Assessment
Clothing/Interview Attire
SPIRITUAL INTERESTS:
Rows
Yes
No
N/A
Grow in relationship
with The Lord
Church Membership
Discipleship
Youth/Children Services
Prayer/Intercession
Marriage Counseling
Pre-Marital Counseling
OTHER DETAILS
Level of Connection made with individual(s)/family
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
TLM Member Completing Form
First Name
Last Name
Submit
Should be Empty: