National Baptist Convention

2017 Chaplain Survey

Chaplain Surveypage 1 of 1
Thank you for taking time out of your busy schedule to respond to our survey. The survey will require only about 10 minutes of your time to complete, but will offer us immeasurable insights into who you are and how we can serve you better. If after completing the survey you'd like to speak with us, please contact Dr. Nevalon Mitchell, Ecclesiastical Endorser, by phone at 301.809.6025 or by email at

Tell Us About You

First Name Last Name
Select one
Less than 30 years
31 to 45 years
46-60 years
61-75 years
76 years or older
Select all that apply
Do not wish to answer
Address Line 2
City State Zip Code
International Address
Email Address
Phone Number
Phone Number

Tell Us About Your Endorsement

Select one
Not currently

Tell Us About Your Work

Select all that apply
Full time
Part time
Occasional/Ad Lib
Unemployed (looking for work)
Retired/Unemployed (not looking for work)
Select one
Not sure
Select all that apply
Military, Stateside
Military, Overseas
Hospital/Medical Facility
Hospice/Residential/Home-based Settings
School (K-12 or College)
Police/Fire Department
Prison/Correctional System
Governmental Agency
Sports Team
Other (tell us where in the next question)

What are your Professional/Personal Development interests?

Select one
Not sure
Select all that apply
Ecclesiastical Endorsement/Certification
Specialty Certifications in Counseling, Mental Health, Etc.
Annual Professional Development Seminar
Professional Development - classroom (ongoing)
Professional Development - online (ongoing)
College credit classes
Personal Support (for you, the chaplain)
Ongoing networking/relationship-building opportunities with other chaplains
National Directory of Chaplains endorsed by or registered with the National Baptist Convention, USA, Inc.
Other/More (enter your responses in the next question)

Your Final Comments

* required