Save America City Impact Assessment

Church & Ministry City Impact -Assessment

Thanks For Serving Your Community
Your Name (Contact Person)*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name of Your Church Or Organization

Make A Positive Impact
Organization Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website:
Do You Believe That God, our Heavenly Father only Created -Male & Female?
Please Check The Services or Outreach Ministries You are currently Providing to Your Community.*

Sunday Worship & PreachingFood PantryWeekday Prayer MinistryHomeless MinistryWeekday Bible TeachingJail or Prison MinistrySunday School for ChildrenRecovery MinistryAdult Sunday SchoolChristian CounselingChurch Bus/Van TransportationChristian SchoolPrayer & Grief ShareESL ServicesChild Care During ServiceSenior Day Center MinistryMarriage MinistrySingle Mom MinistryMinistry To MenJob Assistance - ApprenticeshipWomen's MinistryHospital VisitationYouth MinistryAttend City & School Board MeetingsAfter School Youth MentoringBiblical Citizenship ClassesHome School - Place to MeetCommunity Outreach ProjectsPublic School MentoringADA - Wheelchair AccessPastoral CareUtility and Rent AssistanceCar Repair ProgramHome Repair/Rehab ProgramOther
What Days are You Open to offer These Ministry Services?

MondayFridayTuesdaySaturdayWednesdaySundayThursday
Did you know that the moral condition of a City is a reflection of the Church?
What is the Level of Crime and Violence in Your City?
Are you Pleased with the Moral condition of your Public Schools?*
Are you Pleased with the Moral, Spiritual, Financial, and Political Condition of our Country, The USA?
Do you believe your church or ministry is making a positive impact in your city?
Are you Ready to Learn Key Ways To Maximize Your Ministry Impact?

YesNoIn The Near Future
Needs I/We Have
Please Select A Services Your Church or Ministry May Need

Ministry Consulting/CoachingCoaching for our Pastor/LeaderMinistry Development -CoachingSpeaker for Men's MinistrySpeaker for Church Service/EventCoaching on Community OutreachGun Violence Prevention - TrainingYouth Mentoring TrainingSingle Mom - Ministry TrainingCommunity Impact CoachingCity Impact ConsultingMental Health CoachingAfter School Youth Mentoring TrainingFatherless Youth MentoringOther
Are You Currently In Need of any of These Services Now?*

YesNoIn The Near Future
Do you have any special instructions or comments?
Assistance, training, etc.
Are You Currently Accepting New Volunteers?

YesNoIn One WeekIn Two Weeks 4
How Did you Hear about us?
Thanks for serving your community. By submitting this form, you agree to be added to our email updates.

You also agree to allow one of our team members to contact you by email or phone to discuss your request or ministry impact.

Thanks for serving and making a positive impact.

May God Bless you and your family.

Paul Benjamin

Servant Leader

Save America Initiative
Should be Empty:

Church & Ministry City Impact -Assessment

Name of Your Church Or Organization

Needs I/We Have