1.  Have you ever put anything in priority over serving God?            Yes  Maybe  No

2.  Have you ever made an idol of anything in this world?                Yes  Maybe  No

3.  Have you ever used the name of God in vain?                            Yes  Maybe  No

4.  Have you trusted in your own works to save you from hell?       Yes  Maybe  No

5.  Have you ever shown disrespect to your parents?                      Yes  Maybe  No

6.  Have you harmed any person physically or with your words?     Yes  Maybe  No

7.  Have you lusted for someone who is not your spouse?               Yes  Maybe  No

8.  Have you ever stolen?                                                               Yes  Maybe  No

9.  Have you ever lied about someone?                                          Yes  Maybe  No

10.  Have you ever been jealous of someone else's possessions?     Yes  Maybe  No

11.  Do you love and serve others without selfishness?  Always   Sometimes   Rarely

12.  If you died today do you know for sure where you would spend eternity? Yes   No

13.  If so, where?     Heaven   Hell     Elsewhere   Don't know

14.  How sure are you?  5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

15.  If you chose Heaven, what makes you think you will spend eternity there?
  By loving others   Being a good person  Having faith in Jesus Christ
  Following another religious leader  I'm not going to heaven

16.  Do you believe Jesus Christ is the son of God?  Yes   No

17.  Do you love and serve Jesus?   Yes   No

18. Your Name: