District Affiliated Weekly Report
This form must be filled out by 12:00pm (CST) every Tuesday.
Church Information
Church Name & City
Choose...
Abundant Life AG in Sharon
Christ's Temple AG in Saltillo
City Hope in Springhill
Dancyville AG in Bartlett
Family Hope Church in Pleasant View
First AG in Erwin
First AG in Henderson
First AG in Livingston
First Assembly of God in Madison
Halls, Hope Church in Halls
Hillside Fellowship in Woodbury
Hmong AG in Medon
Jefferson City AG in Jefferson City
Nueva Vida in Memphis
Poplar Grove in Drummonds
Providence Church AG in Jamestown
Randolph Assembly of God in Burlison
Refuge Assembly in Soddy
The Assembly in Lebanon
The Collectives in Cleveland
Thrive AG in Oneida
Victory AG in New Tazewell
Vision Church in Winchester
Whitefield Assembly of God in Ripley
Please select a church.
Senior Pastor
Choose...
No Pastor
Ben Herzog
Brad Schoeneck
Dennis Parillo
James Harris
Jeff Pitts
Jerry Buck
Ly Vu
Marty Cooper
Michael Vandergriff
Mike Hinkle
Mike Roggero
Open
Open
Ralph Crass
Robert Brooks
Robert Frazier
Rolando Rostro
Rusty Fletcher
Ryan Forkel
Scott Waycaster
Shawn Anderson
Tim VanDouser
Vic Henry
Zachary Roper
Please select a pastor.
Week of
Please select the report date
Are you the pastor?
Choose...
Yes
No
Please select an option.
Your Name
Your Position
Attendance
Sunday School
Sunday Morning
Sunday Evening
Midweek Service (Previous Week)
Membership Data
Membership Count
Salvations
Water Baptisms
Holy Spirit Baptisms
Mortgage Information
Total Amount Owed
Amount of Last Payment
Date of Last Payment
Insurance Information
Are your Insurance premiums with Brotherhood Mutual Insurance current?
Choose...
Yes
No
Please select an option.
Please select an option.
Are you providing separate child care, children's or youth ministries during any of your church meetings (including those held in pivate homes)?
Choose...
Yes
No
Please select an option.
Are you holding church meetings in a leased, rented or donated facility other than a private home?
Choose...
Yes
No
Please select an option.
If yes to either of the above two questions, have you arranged for property liability coverage with Brotherhood Mutual?
Choose...
Yes
No
Please select an option.
Please select a valid country.
Finances
Please round all values to the nearest whole number
Income - Current Sunday Giving
Total Income
Account Balances
Checking Balance
Savings Balance
Other Notes
Submit Report
