Quick and easy survey. Takes two minutes.
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Check if this is you.

I want to make a difference.
I want to make my world a better place.
I want to build God's kingdom.
I have a dream.
I want to leave a legacy.

Here's how clear I am on how I want to do that.
very clear
kinda clear
fuzzy
clueless

I want to start a ministry.
I want to support an established ministry
I want to start a business.
I want to advance a cause.
I want to be a friend / strengthen a relationship.

I welcome help for what I checked above.

Here's the help I would like ...

prayer
encouragement
inspiration
books
DVDs/online videos
courses

connecting with friends to discuss this
meet new people who share my desires / goals
help clarifying my mission, role or goals
information about ministry / other opportunities available for me

coaching services
mentoring or consulting
business plan development
ministry plan development
help communicating my vision to others

other help

I would like to get this help  (check either or both)
online
off-line

Some help is free (prayer, encouragement, friends, etc.)
Some help is not free (books, coaching services, courses, etc.)
How much would you be willing to invest in the kind of help you checked above? (This is just a survey, not a commitment.)
$250+/month
$101-$250/month
$51-100/month
$26-50/month
$10-25/month
under $10/month

I am ...
female
male

Age
under 13
13-17
18-19
20-24
25-29
30-39
40-49
50-59
60+

(Optional but very helpful) If you attend a church, could you please give the name of the church and the  location.



I (Dwight Clough) am creating a free networking site to empower people to make a difference in the ways you described above. I would love to have your input on how to design and promote this site. Would you be willing to (either or both)
be interviewed over the phone for 15 minutes?
participate in a 90 minute focus group meeting?
If you checked either of the above - could you please provide your name, phone, best time to call, and email.

If you are under age 13, please do NOT provide any personal information. (Sorry, it's the law.)

Optional

Name


Phone and best time to call


Email

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