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Spiritual Interest and Support Assessment
The purpose of this survey is to identify areas of spiritual interest in order to determine if further conversation about spiritual support would be helpful. Thank you for taking this assessment!
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Email
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Your email
If you are taking this assessment on someone else's behalf, please tell us your name and relationship to the person who spiritual interests are being assessed?
Your answer
Name of the person whose spiritual interests are being assessed:
Your answer
What is your/their most immediate need?
Your answer
Have you/they had any significant losses or changes within the last 2 years?
Your answer
Overall, how are you/they doing right now?
In Crisis
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Best Life
Clear selection
General Spiritual Interests
This section identifies spiritual interests that are NOT connected to a particular religion.
Enjoys nature
Never
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Always
Clear selection
Shows compassion to others
Never
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Always
Clear selection
Enjoys helping others
Never
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Always
Clear selection
Enjoys quiet time alone
Never
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Always
Clear selection
Enjoys being creative with their hands
Never
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Always
Clear selection
Enjoys spending time with friends and family
Never
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Always
Clear selection
Enjoys exercise or playing sports
Never
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Always
Clear selection
Expresses spiritual gifts (praying, leadership, encouraging, justice-seeking, peace-making)
Never
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Always
Clear selection
Enjoys meditation or private prayer
Never
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Always
Clear selection
Please list specific examples for each spiritual interest which scored 7 or above. A specific example of enjoying nature could be "points to all of the birds during walks." A specific example of expressing spiritual gifts could be "helps roommate calm down after a panic attack."
Your answer
Religious Interests
This section identifies practices and interests that are connected to a specific religion
Shows interest in religious media ie TV shows, movies, books or music
Never
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Always
Clear selection
Prays for help or healing for self and others
Never
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Always
Clear selection
Leads blessings or prayers
Never
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Always
Clear selection
Shows interest in religious holidays (decorations, foods, songs, traditions)
Neve
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Always
Clear selection
Uses, carries or displays religious objects (rosary, yamulkah, prayer rug) or texts (Bible, Qu'ran)
Never
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Always
Clear selection
Knows the words to religious prayers, hymns or chants
Never
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Always
Clear selection
Chooses or refuses certain foods or activities for religious reasons (no pork, vegetarianism, no caffeine, no photographs, no dancing)
Never
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Always
Clear selection
Expresses particular values, opinions or beliefs based on religious commitments (anti-death penalty, anti pre-marital sex, anti-war, anti LGBTQ, generosity to the poor, modest dress)
Never
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Always
Clear selection
Chooses or rejects certain clothes, hair styles, products for religious reasons (no shorts or short skirts, always or never facial hair, no make-up, no leather)
Never
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Always
Clear selection
Expresses interest in attending or participating religious rituals (fasting, bar mitzvah, communion, baptism, ashes, anointing, confession, blessing)
Never
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Always
Clear selection
Please list specific examples for each religious interest which scored 7 or above. A specific example of showing interest in religious holidays could be "asks for matzah bread during Passover." A specific example of expressing interest in religious rituals could be "gets very vocal when communion is served."
Your answer
Faith Community Interests
This section identifies practices or interests that are connected to a particular faith community
Attends worship services
Never
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Always
Clear selection
Participates in classes, small groups or studies provided by a faith community
Never
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Always
Clear selection
Attends social or holiday events hosted by faith communities
Never
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Always
Clear selection
Has volunteer roles (reader, usher, greeter, candle lighter, teacher)
Never
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Always
Clear selection
Acts a leader or committee member
Never
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Always
Clear selection
Helps prepare, serve or clean up refreshments at faith community events
Never
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Always
Clear selection
Helps care for children or children's programs (nursery, education classes, set-up classroom, prep materials, clean-up classroom)
Never
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Always
Clear selection
Sings in a choir or plays an instrument during congregational gatherings
Never
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Always
Clear selection
Gives money to a faith community
Never
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Always
Clear selection
Helps care for faith community's physical spaces by setting up or putting away chairs and tables, doing indoor or outdoor clean-up, caring for plants
Never
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Always
Clear selection
Has participated in religious ceremonies or rituals (bar mitzvah, membership, baptism, marriage, confirmation, mikvah, pilgrimage)
Never
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Always
Clear selection
Please list specific examples for each faith community interest which scored 7 or above. A specific example of participating in small groups or classes could be "Sunday morning bible study." A specific example of acting as a leader or committee member could be "attends annual meeting"
Your answer
A copy of your responses will be emailed to the address you provided.
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