The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

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Required format:

i35XJpUbPAvf8AFP2ti6RBRGFkgnP8xJ63ndTMLMCsRP8vE2kS6e9mmtBPyMNixwNHCSgL9vhtygWznSjucQ8tBGGdFxSn6hQaSbXTX3ppqbKWi4uKp9eWRKbx3

Gifts and Needs Assessment for Places of Worship

The Tennessee Department of Health (TDH) is dedicated to eliminating health disparities, ensuring everyone in our state has the same opportunities for optimal health. Partnering with faith communities is key to closing the health gap.

By participating in this survey, you will help us understand the health needs and strengths of your congregation. We want to learn about the resources you have and how we can work together to support the health of your members.

This information will be used internally to help us create programs and resources that are specifically designed to meet the needs of our faith-based organizations.

Name of your Place of Worship:

* must provide value

First and Last Name of Faith Leader
(pastor, priest, rabbi, imam, etc.):

Information for primary contact person for health initiatives/congregational care:

Name:

* must provide value

Phone:

* must provide value

Email:

* must provide value

Street Address of Place of Worship:

City of Place of Worship:

* must provide value

County of Place of Worship:

* must provide value

Website and/or social media pages of place of worship, if applicable:

Place of Worship's Denomination/Faith Tradition:

* must provide value

Roman Catholic

Orthodox (Greek, Russian, etc.)

Protestant

Anglican/Episcopal

Baptist

Methodist

Lutheran

Presbyterian

Pentecostal

Reformed

Adventist

Church of Christ

United Church of Christ

Evangelical

Non-denominational Christian

Church of Jesus Christ of Latter-day Saints

Jehovah's Witnesses

Judaism

Islam

Buddhism

Hinduism

Other

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If Other Denomination or Faith, please specify:

Approximate Size of Congregation:

* must provide value

Fewer than 50 members

50 - 100 members

101 - 250 members

251 - 500 members

501 - 1,000 members

More than 1,000 members

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If Other Health Condition, please specify:

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.