School District: __________________    School Board Ph.# _____-_____-_______ Date:____/___/____
School Name: _________________________
School Address: _______________________
: __________________________________
School Contact: ___________________________________
School Ph # : ______-_____ -____________ _ _
School Fax # : ______-_____ -___________ _ _
Organizer: __________________________ 

Org. Addr: __________________________ 
City/St/Zip: __________________________
Org. Ph # :  ______-_____ -_____________ _ _
Org. Fax # : ______-_____ -____________ _ _
Org. Email : ________________________ _ _
Instructions:  Please check the Yes or No blocks to indicate your interests.   At the bottom, fill in your contact information (with Comments) and return the survey to the Organizer listed above.    | Organizers: Survey Guidelines |
'[] new window Refs []' = For National /USA/ references or For additional resources & /HowTo/ Start information.
Check all that apply:. Registered voter check boxRegistered Voter ;. Pay school taxes check boxPay School Taxes ; . Parent or grandparent of public school kids check boxParent (or Grand) of PS kids;
Y   N   GENERAL
  1. Are children important to you? or Do you think they are special?
  2. Do you think the school's subjects, examples and methods of teaching our children how to live is better [Y] or worse [N] than when you went to school?

Y   N   RELIGION
  3. Do you believe that each person has a spirit and that it requires nourishment & development?
  4. Are you opposed to Christian religious speech in our public schools?
  5. Would you favor a law allowing elective non denominational Christian classes in public schools?
Y   N     PRAYER   . . .    usa 1, [] usa Prayer 1 []
  6. Would you be interested in encouraging and supporting student school prayer groups?
  7. Would you be interested in encouraging and supporting school teacher prayer groups?
  8. Would you be interested in hosting a Parents Prayer Partner group near the school?
Y   N     ON CAMPUS  BIBLE  CLUBS  AND  CLASSES  . . . [] usa Class 3 [] [] usa Clubs 2 [] , [] usa Prayer 1 []
  9. Would you approve of elective non sectarian ON Campus classes of History or Literature for credit where the text is the Bible? ,[] How To Start a Bible Class []
  10. Would you approve of students & parents starting a student [] prayer group [] or [] Bible Club [] ?
Y   N   OFF CAMPUS  RELIGIOUS  BIBLE  CLASSES  . . .    usa 4   |  [] usa 4 [] , [] How To start an RT class [] .
  11. Would you be interested in knowing about elective OFF campus Christian Religion Bible Classes called Released Time Bible Classes and other extracurricular programs of this nature?
  12. Would you host an elective OFF Campus Released Time Bible Classes?
  13. Or do you know of a place near the school where elective OFF Campus Released Time Bible Classes could be held?

Y   N   OTHER  INFORMATION & INTERESTS   . . .   [] usa 5 [][] HowTo start Teacher Reacher Cards [],
  14. Would you like more information about sending our public school teachers and administrators Special Holiday Cards for their encouragement and support?
  15. Would you like more information about our public school library and its policies on non censored books, magazines, internet pornography, and unrestricted access to items that could be inappropriately available to your neighbor's minor child?  . . .   usa 6   |  [] usa 6 [] ,
  16. Do you support free speech to minor school children that promote: anti-social, criminal, psychopathic and other abnormal behaviors? ( like: pornography, prostitution, sodomy, pedophilia, etc.)
  17. Should only abstinence and sexual purity be taught in our PS's sex ed. classes?  [] usa 8 [] , [] How To start Abstinence in PS []  .
  18. Would you like to know what your school's policies are, and what information and materials are being presented in the sex education classes?
  19. Would you like to know the results of this survey? By NewsletterBy Email?  (If Yes, Circle one.)

 Y   N  TIME  AND  TALENTS    (Organizers:   For your local Help Inform: or [] national []  )
  20. Would you be willing to give of your time and talents to promote these activities?  Please place a number next to the heading, in order of preference, where you would like to serve.
 ______ PRAYER ; _____ ON CAMPUS  BIBLE  CLASSES  AND  CLUBS ;
 ______ OFF CAMPUS RELEASED TIME  BIBLE  CLASSES ;  _____ OTHER  INFORMATION & INTERESTS ;
 ______  I will HOST or ATTEND (Circle one.) a follow up meeting or discussion group ;
.
 Y   N  DONATE
  21. Would you be willing to donate to Hisways® USA, Inc. []  501(c)3  [] to sustain these activities?

All contact information and any comments (write them in the space below) will be kept confidential.
Name: _____________________________ 
Addr: ______________________________ 
:___________________________________ 
City/ St / Zip: ___________________________
Ph #    ______ -_______ -____________ 
Fax #   ______ -_______ -__________ _ 
Email: __________________________ _ 
 ______________________________ _

Permission is granted to duplicate and distribute, unedited, for noncommercial purposes.
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COMMENTS:_________________________________
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