Reporting Results (Off- line)

Below is a form with instructions which will walk you trough off-line reporting. Print the form, fill in the blanks, and return the results to:

A report will be coming to you in the mail in a few weeks summarizing your results. This is what you will photocopy to provide for those in the community who responded "yes" to Question 14 on the survey.

Reporter Info:

Reporting Date ___/___/___ (when you filled out this form)
Name_________________________________ Phone _____________________
E-mail___________________@________________________
Church/Organization______________________________________________
Address__________________________________________________________
City____________________________State____Zip________Country______

General Info:

How many surveys are included? ___________

Dates covered by survey from ___/___/___ to ___/___/___

Survey Version ______ (Look at bottom of page near "[Jerry Dyer]". If

no version is indicated your version is 1.00, please remember this

for later.)

Felt Needs:
This is addressed by questions 1-6 (1-7 version 1.00) on the top of
 
the survey.
(Version 1.00 skip #1 start with #2 since #1 was omitted because of
 redundancy --
all other versions disregard)

List 5 most common answers for:
Question 1  1)_____________________    Question 2  1)_____________________
            2)_____________________                2)_____________________
            3)_____________________                3)_____________________
            4)_____________________                4)_____________________
            5)_____________________                5)_____________________

Question 3  1)_____________________    Question 4  1)_____________________
            2)_____________________                2)_____________________
            3)_____________________                3)_____________________
            4)_____________________                4)_____________________
            5)_____________________                5)_____________________
 
Question 5  
Tally Yes____ Average how many_____________________
List top 3 versions 1)_____________________
                    2)_____________________
                    3)_____________________
            
Question 6
Tally Each: ___Catholic ____Jewish ___Protestant      1)_______________
                                      List top        2)_______________
                                      3 Affiliations  3)_______________
Other:____ Top 3 1)_____________2)_________________3)__________________

Opinion Questions:
Tally each of the following responses for each number.
 1)____Y____N____UD |  2)____Y____N____UD |  3)____Y_____N____UD 
 4)____Y____N____UD |  5)____Y____N____UD |  6)____Y_____N____UD
 7)____Y____N____UD |  8)____Y____N____UD |  9)____Y_____N____UD
10)____Y____N____UD | 11)____Y____N____UD | 12)____Y_____N____UD
13)____Y____N____UD | 14)____Y____N____UD 

Thank you for contributing!