| Name: |
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| Street Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Email Address: |
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| Cell Phone: |
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| Home Phone: |
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| Spouse's Name: |
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| Children's Ages: |
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| How long have you lived where you are now?: |
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| Are you comfortable with the idea of relocating to northern Illinois or southern Wisconsin?: |
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| Where are you interested in planting a church? (must be northern Illinois or southern Wisconsin): |
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| Why are you interested in planting a church?: |
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| Have you planted a church before?: |
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| What have you started from scratch before?: |
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| Briefly describe your understanding of the Gospel: |
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| Briefly describe the church you envision planting: |
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| If you could change two things about the church in America, what would they be?: |
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| Are there any areas of doctrine or theology that are extremely important to you? (examples: charismatic issues, calvinist/arminian issues, baptism issues, etc.): |
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| Name your 3 favorite Christian books: |
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| Who are your favorite theological writers?: |
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| List 3 adjectives your spouse or friends would use to describe you: |
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| List 3 adjectives you would use to describe yourself: |
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| List your 3 greatest personal strengths: |
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| List your 3 greatest personal weaknesses: |
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| Have you read the New Wineskins Core Values? Do they resonate with you?: |
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| Do you rent or own your place of residence?: |
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| What is your total non-mortgage personal debt?: |
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| Why do you believe you are well suited to plant a church?: |
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| What church are you currently part of? (please list city, state, and website): |
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| What do you like most about that church?: |
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| What do you like least about that church?: |
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| Are you in a leadership role there? If so, what?: |
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| Please list past leadership roles you have served in, along with the church or organization served, and the years you served in that role: |
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| List all colleges, graduate schools, seminaries, and training programs attended, the years you attended each one, and the degree or certificate earned: |
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| Are you willing to work and/or raise funds to make planting a church possible?: |
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| What questions do you have for us at New Wineskins?: |
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