PERSONAL MINISTRY QUESTIONAIR

The purpose of this form is to obtain a comprehensive picture of your background.  By completing these questions as fully and accurately as you can, you will facilitate your ministry.  You are requested to answer these questions as though you have never had any ministry over these issues before.  During the initial session we will ascertain which issues we do not need to revisit.

PLEASE:  In sections where questions require a YES  or  NO  answer, only mark a response where your answer is YES.  If your response is NO, move on to the next question.  If some particular question does not apply to you, such as previous marriage, simply write “N/A”

					DATE_____________________________
I.  GENERAL INFORMATION

A.  NAME __________________________________________________________________________

      E-MAIL ________________________________________________________________________

B.  ADDRESS _______________________________________________________________________

      CITY _______________________________________STATE____________ZIP_______________

_____ Are you born again?	_____ Have you been water baptized?
_____ Were you water baptized before your received Jesus?

G.  Why do you feel called to the Deliverance Ministry? 
_______________________________________________________________________________

H. Marital Status (circle one);

  Single   Engaged   Married   Separated   Remarried   Divorced   Widowed

I.  Is your husband/wife in agreement to you working in this ministry?

	   Very much             Somewhat              Moderately            No, it is what I want

J. Explain in your own words the issues you are dealing with that you need to address before you can be released to work in this ministry.  Please be as specific as possible.  Include a few examples detailing how the problem surfaces.

A.  State the nature of your chief concern:_______________________________________________

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B.  Have you gone to GOD for this situation? ___________________________________________

C. When did the problem begin? ________________________________________________________

D. List the people who are directly affected by these issues;  __________________________________

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E. How does this problem affect your relationship with God? _________________________________

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G. Are there any other past issues you need to address before you are released into this ministry?  

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G.  JUDGEMENTS AGAINST PASTORS/CHRISTIANS/GOD

AGAINST PASTORS			AGAINST CHRISTIANS
_____Unavailable				_____Hypocrites
_____Unteachable				_____Free loaders
_____Not handle money well			_____Deceived
_____Have money motive in heart		_____Weak
_____Building own empire			_____Lazy
_____Compromising				_____Compromising
_____Hypocrites				_____Undisciplined
_____Manipulative				_____Won’t keep their word
_____Controlling				_____Not trustworthy
_____In it for self gain			_____Superficial
_____Refuse personal relationship		_____Arrogant
_____Prefer others/have favorites			_____Critical/Judgmental
_____Can’t see the whole picture			_____Weird
_____Not trustworthy to keep a confidence
_________________________________		______________________________
_________________________________		______________________________
_________________________________		______________________________

AGAINST GOD

_____Doesn’t love me		
_____Doesn’t hear me
_____Doesn’t protect me	
_____Isn’t there for me
_____He’s confusing
_____Hard to please
_____Abandons me		
_____Clobbers me for a mistake
_____Not able to be trusted	
_____Too busy for me
_____Not consistent
_____Doesn’t provide for me	
_____Prefers others
_____Isn’t interested in me	
_____Doesn’t keep his promises
_____Distant		
_____Indifferent to my needs
_____Betrayed me		
_____Made a mistake when he made me
_____Disappointed in me

Others;  ________________________________________________________________________

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H.  INNER VOWS
_____I’ll not be like my father (mother).		
_____I’ll not discipline my kids like I was.
_____I’ll not treat my kids like my parents treated me.
_____I’ll never leave and desert my wife (husband) and kids.	
_____I’ll never get married (again).
_____I’ll never do __________________ again
_____I’ll never let anyone man/woman get close to me again.
_____I’ll never marry anyone like my mother/father.
_____I’ll never go to work and leave my kids home alone.
_____I’m going to make sure my kids get the things I didn’t.	
_____No one’s going to tell me what to do.
_____No one’s going to tell me what to eat.
_____No one’s going to control me again.
_____No woman is going to control me like my mother did my father
_____I’ll never trust another man/woman
_____I’ll never let another man/woman take advantage of me
_____I’ll never work for another man/woman		
_____I’ll never hire another Christian
_____I’ll never do business with another Christian	
_____I’ll never trust another pastor
_____I’ll not treat my spouse like my father/mother did
_____I’ll not scream and holler at my kids like my mother/father did
_____I’ll never go to church again			
_____I’ll never work for anyone else again
_____I’ll not submit to any man, only Jesus
_____I’m not going to let anyone walk all over me	
_____I’ll never get free
_____I’ll never lose weight/quit smoking/drinking etc.
_____I’ll never let my kids go through what I went through
_____My kids will all have a college education		
_____I’ll kill the person who molests my child		
_____I’ll make it by myself
_____I’m trapped and can never get out of _______________________________
_____No one will ever control me   			
_____No one will tell me what to do  
_____I don’t have to listen to anyone  
_____I’ll not trust or believe another pastor
_____I’m not going to let the boss walk all over me
_____I’m not going to tell my boss any more than I have to.

    Other vows______________________________________________________________________

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I.  WORD CURSES

SPOKEN BY OTHERS				SPOKEN BY SELF

_____		You’ll never amount to anything		_____
_____		You’re a failure/loser			_____
_____		You’ll never succeed			_____
_____		You never finish anything		_____
_____		You are a born loser			_____
_____		You are dumb/stupid			_____
_____		You are lazy			_____
_____		You can’t do anything right		_____
_____		You never remember anything		_____
_____		You are a tramp/slut			_____
_____		You’re a liar			_____
_____		You’re a thief			_____
_____		You’re just like your father/mother	_____
_____		You’re rebellious/stubborn		_____
_____		You’re an accident waiting to happen	_____
_____		You never do it right the first time	_____
_____		You’re accident prone			_____
_____		You can’t memorize scripture		_____
_____		You’re weak/passive			_____
_____		You break everything you touch		_____
_____		You always say the wrong thing		_____
_____		You have no creative ability		_____
_____		You are no good with numbers		_____
_____		Money burns a hole in your pocket	_____
_____		You’re going to have a breakdown	_____
_____		It will only get worse			_____
_____		You’ll be an alcoholic all your life	_____
_____		I’ll never have a baby			_____
_____		It is terminal			_____
_____		You can’t be trusted			_____
_____		You will die young			_____
_____		You will never get married		_____
_____		You’ll never have money		_____
_____		You’ll die young			_____

Others:_____________________________________________________________________________

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End    3-25-06