Parish Name*
Parish Address*
Name of person completing form
E-Mail of person completing form (or best parish contact)
Supportive Services :
How does the parish or a parish group provide supportive services for mothers and fathers in need, babies at risk, the elderly / terminally ill, and individuals impacted by the death penalty?
Check all that apply:
Support for mothers and fathers experiencing an unexpected pregnancy:
Posting “Baby Due” or “Pregnant, Need Help” sign outside parish Signage in church and / or bulletin inserts offering help Directly providing material or financial assistance Referrals to pregnancy resource centers (e.g. White Rose, Birth Choice), Project Gabriel, or other organizations for pregnancy / parenting assistance Promotion of the option of adoption / referrals for adoption assistance Providing prayer volunteers regularly outside abortion facility Other
Support for mothers and fathers who have experienced pre-born infant loss:
Signage or bulletin insert promoting post-abortion healing (e.g. Project Rachel, Project Joseph, Rachel’s Vineyard) Parish priest or deacons volunteering to serve on Rachel or Joseph retreats Signage or bulletin insert offering healing / promoting ministry for miscarriage loss Parish-led ministry to support parents experiencing pre-born infant loss Burial support for children lost before birth Other
Support for the elderly and terminally ill:
Visits to the hospital, hospice, homebound or assisted living facilities by clergy Parish-sponsored visits to the hospital, hospice, homebound, or assisted living facilities by lay persons Parish-led healing ministry for those who are in hospice or are homebound Providing sacraments to those who are in hospice or are homebound Living support for the homebound (meals on wheels, financial assistance, Christmas / Easter support, etc.) Other
Support for individuals impacted by the death penalty:
Parish-led Prison Ministry / Visits Providing church services or sacraments to those in prison Other
If you selected "Other" in response to any of the supportive services questions above, please explain:
Fundraising / Donations for Local Support Ministries:
Check all that apply:
What fundraising efforts do the parish or parish groups undertake to support the needs of mothers in
Baby Bank Campaign through the Catholic Pro-Life Community Drives to collect material donations for pregnant / parenting mothers in need (e.g., diapers, car seats, clothing, food, etc.) Parish tithing or second collection to support organizations that assist mothers in need (e.g., Project Gabriel, White Rose, Birth Choice, Bella House, Mater Filius) Hosting Table(s) at Bishop’s Pro-Life Dinner Fundraisers for Parish Respect Life Ministry Other
If you selected "Other" in response to the fundraising question above, please explain:
Parish Respect Life Ministry:
Does the parish have an active Respect Life Ministry?
Single Individual Small Group (< 5 participants) Large Group (> 5 participants) Not at this time
If you have a parish pro-life coordinator, that person is
Lay Person Clergy Member
Do the members of the Respect Life Ministry regularly meet?
Yes, monthly Yes, quarterly No
Does the Parish Pro-Life Coordinator meet with clergy or parish staff regarding respect life ministry / activities? (Pick all that apply)
Yes, with pastor Yes, with priest or deacon other than the pastor Yes, with a parish staff person No
Does the Respect Life Ministry have a budget for respect life efforts / activity?
Yes No
Parish Engagement
Respect Life intentions / announcements include topics such as protection of the unborn; end to abortion, euthanasia, assisted suicide, and the death penalty; or support for pregnant mothers, the option of adoption, those who experience abortion or miscarriage, and those who are terminally ill or on death row.
Select all that apply
Holy hours, Mass intentions or prayer groups dedicated to respect life:
Adoration for Life Rosary for Life Mass Intentions for Life
If your parish has Adoration, Rosary or Mass intentions for Life, how frequently?
Monthly Quarterly Annually
Announcements or Exhibits dedicated to respect life:
Bulletin Announcement / Inserts Pulpit Announcements Dedicated Display Space (e.g., bulletin board, brochure rack) Respect Life Exhibit Table after Mass or at Parish Ministry Fair Other
If your parish includes respect life items in your bulletin, how frequently?
Monthly Quarterly Annually
If your parish makes pulpit announcements about respect life, are they related to: (check all that apply)
Respect Life Ministry Respect Life Events Respect Life Education
Parishioner / community activities dedicated to respect life awareness and engagement in the last three years:
Roe v. Wade Mass and North Texas March for Life Promotion of other diocese-wide public events* Parish-Led Prayer Campaign or Spiritual Adoption (e.g., campaign to pray for an unborn baby in the womb) Parish Community Event (e.g., pro-life movie night, pro-life luncheon or dinner) Parish Public Witness / Advocacy Campaign (e.g., pro-life display, postcard campaign, death penalty vigil) Other
*Diocese-wide activities include Advocacy Day, Pro-Life Stations of the Cross, 40 Days for Life, Respect Life Month Mass, Pasos por la Vida, Bella Vida
If your parish participates in the Roe v. Wade Mass and/or NTX March for Life, please check all that apply:
Promote the event Send a parish group Provide Transportation
If you selected "Other" in response to the questions above regarding announcements, exhibits or activities, please explain:
Respect Life Education:
Respect Life issues include topics such as contraception, abortion, euthanasia, assisted suicide, the death penalty and bioethics (e.g., IVF, embryonic stem cell research, cloning)
Please pick all that apply
Does the parish currently incorporate education on respect life issues into its adult and youth catechesis and ministry programs?
Lessons are presented by parish educators / leaders Presentations by outside speakers invited into parish to present Parish-hosted pro-life event for youth (e.g. Lock-in for Life) Parish-hosted conference, speaker-series or seminar Parish-sponsored trip / scholarships to D.C. March for Life Promotion of and / or parish-funded scholarships for Pro-Life Boot Camp Other
If your parish educators / leaders present on respect life issues, please identify to which groups they present:
Middle School Ministries High School Youth Ministry Young Adult Ministry Adult Ministries
If your parish invites outside speakers on respect life, to whom do they present?
Middle School Ministries High School Youth Ministry Young Adult Ministry Adult Ministries
If you selected "Other" in response to the education question above, please explain:
Are there any other ways the parish creates a Culture of Life within the Church environment?
Are there any additional resources you would like to assist in creating, promoting and supporting a Culture of Life in your parish community?
