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The following questions are to be answered by the applying 7th through 12th grade student in his/her own
handwriting. If more space is needed, use a separate sheet putting the student’s full name in the upper right corner
and then in the left column, numbering the questions being answered. This completed questionnaire must be
returned with the rest of the packet.
0 I. Questionnaire
Does your church have a youth group? Yes No Are you active in the youth group? Yes No
In what way are you active?
Do you have a regular time for Bible reading and prayer? Yes No Why or why not?
Describe some areas of your life in which you feel God is now working?
8. What type of music do you listen to? (classical, contemporary, country, rock, heavy-metal, etc.)
11. Do you have a job after school or on weekends? Yes No If so, what is it?
14. Have you ever been suspended or expelled from school? Yes No If yes, explain in detail.
15. Have you ever been in trouble with the police or the law? Yes No If yes, explain in detail.
16. Have you ever used tobacco? Yes No Drugs? Yes No Alcoholic drinks? Yes No
If any yes answer, please explain fully.
17. On a separate sheet of paper, write your testimony of salvation which deal with the following questions:
a) According to the Bible, what is a Christian?
b) According to the Bible, how does one become a Christian?
c) When and how did you become a Christian?
18. Did you have any help answering the above questions? Yes No If so, explain which questions
and how much help you received.