Date:                    _

 1. Do you believe abortion is acceptable?                                   Yes        No       ____________________
 2. Do you believe drinking alcohol is acceptable?                        Yes        No       ____________________
 3. Do you believe sex outside of marriage is acceptable?             Yes        No       ____________________
 4. Do you believe homosexuality is acceptable?                          Yes       No        ___________________
 5. Do you believe Jesus Christ is the Son of God?                       Yes        No       ___________________

 6. Do you believe that the following things are agreeable to the teachings of Jesus?
            A. Abortion                        Yes        No                C. Sex outside marriage      Yes      No
            B. Drinking Alcohol            Yes        No                 D. Homosexuality               Yes      No

 7. Do you believe that the Bible is the Word of God?                  Yes               No
 8. Do you believe there is a Heaven?                                         Yes               No
 9. Do you believe there is a Hell?                                              Yes               No
10. Do you believe there is a devil?                                             Yes               No
11. How often do you read the Bible?
              Daily    Weekly             Occasionally              Hardly Ever                  Never
12. Is the Book of Romans in the Old Testament or New Testament?             Old          New
13. Who was Elijah?              Disciple     King     Greek Philosopher     None of the above

14. Name two people who walked on water   (A)__________________    (B) _________________

15. How often do you pray?              Daily      Weekly      Occasionally      Hardly Ever      Never
16. How often do you attend church?                                                                                                                                    1 time a week      2+ times per week      Occasionally      Hardly Ever      Never
       Where? ________________________________
17. If you died today, do you know for sure where you would spend eternity?             Yes             No
            If so, where?     Heaven     Hell     Elsewhere     Don’t know
            From 0-100% how sure are you that you would spend eternity there? __________

18. If someone asked you how to get to Heaven, what would you tell them?___________________________            ____________________________________________________________________________________

19. How would you rate your relationship with Jesus on a scale of 1-10?     1  2  3  4  5  6  7  8  9  10

20. Has your relationship with Jesus gotten stronger or weaker in the past year?  _________________________

21. In John 3:3 Jesus says “Unless a man is born again he shall never see the Kingdom of Heaven.”  What do you think that means? _______________________________________________________________________
__________________________________________________________________________________________

22. In Revelations 3:15-16 God says, “I would rather that you were hot or cold but as you are lukewarm I shall spew you from my mouth.”  What do you think this means? __________________________________________
__________________________________________________________________________________________

Name_________________________________ Address_____________________________________________

Phone Number ___________________ Prayer Requests ____________________________________________
__________________________________________________________________________________________

You may copy this survey, but please contact and send testimonies to
Mark Randall at:   mark.randall@murraystate.edu            www.ReachtheLost.com       (270) 753-9786