Please provide the requested information as it applies to you for the past twelve months ending November 30th of the current year. Complete the survey by December 31st.

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* 1. Your first name:

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* 2. Your last name:

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* 3. Your parish of assignment:

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* 5. Has your contact information changed since last year:

If yes, please provide current contact information in the following fields: current phone number and your address. If no, then leave the next two questions blank.

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* 6. Phone number i.e. 4145551111

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* 7. Your address:

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* 8. Your spiritual director's name:

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* 9. How often do you meet?

Retreats

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* 10. What is the start date of your most recent retreat?

Date

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* 11. What is the end date of your most recent retreat?

Date

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* 12. Where did you go for your most recent retreat?

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* 13. Who was the retreat director/master for your most recent retreat?

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* 14. Would you recommend this person or persons for other retreats?

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* 15. Did you attend another retreat this year (if no, skip to question # 21)

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* 16. What is the start date of your other retreat?

Date

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* 17. What is the end date of your other retreat?

Date

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* 18. Where did you go for your other retreat?

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* 19. Who was the retreat director/master for your other retreat?

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* 20. Would you recommend this person or persons for other retreats?

Courses, Workshops, Seminars, etc. Please list up to six courses, workshops, or seminars you attended this year.

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* 21. Please list courses, workshops, or seminars you attended:

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* 22. Would you recommend for brother deacons or spouses?

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* 23. Please list courses, workshops, or seminars you attended:

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* 24. Would you recommend for brother deacons or spouses?

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* 25. Please list courses, workshops, or seminars you attended:

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* 26. Would you recommend for brother deacons or spouses?

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* 27. Please list courses, workshops, or seminars you attended:

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* 28. Would you recommend for brother deacons or spouses?

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* 29. Please list courses, workshops, or seminars you attended:

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* 30. Would you recommend for brother deacons or spouses?

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* 31. Please list courses, workshops, or seminars you attended:

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* 32. Would you recommend for brother deacons or spouses?

Future Formation Activities
What types of continuing formation workshops or seminars would you find helpful to your ministry?

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* 33. Please list formation workshops or seminars you would find helpful:

Reading Materials

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* 34. Please enter six books or periodicals that you recommend:

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* 35. List additional books you recommend:

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* 36. Are there any titles you do NOT recommend? If so, please list them and and why you do not recommend:

Formation Plan

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* 37. What are your anticipated and desired formational activities for the next 5 years?

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* 38. Is the yearly reimbursement amount of $1100 for Continuing Formation adequate?

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* 39. Please enter any additional comments here:

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