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About
About
The Vision
Our Mission
Our Beliefs
Our Team
Resources
Blogs
Events Calendar
Podcasts
Prayer Wall
Remnant Bible Academy
Ministerial Ordination
Bible Study Resources
IAOM Merch
The Remnant Bible Study – Review Panel
Books For Sale
R.S.O. Portal
Beyond the Label Podcast
Registered Citizens Blogs
Registered Citizen Information & Resources
Contact
General Volunteer Application
Blog Author Application
Prayer Team Application
Support
First Name
Middle Name
Last Name
Age
Date of Birth
Address (Number & Street)
City
State
Zip Code
Email
1. Describe your relationship with your parents, step-parents, siblings, when you were a child.
Biological Father
Good
Bad
Indifferent
Biological Mother
Good
Bad
Indifferent
Step Father
Good
Bad
Indifferent
Not Applicable
Step Mother
Good
Bad
Indifferent
Not Applicable
Siblings
Good
Bad
Indifferent
Not Applicable
2. Were you a wanted/planned child?
Yes
No
Don't Know
3. Were you the sex (gender) your parents wanted?
Yes
No
Don't Know
4. Were you conceived out of wedlock?
Yes
No
Don't Know
5. Were you adopted?
Yes
No
Don't Know
6. Did your mother suffer any trauma during her pregnancy?
Yes
No
Don't Know
7. Are your parents living?
Mother
Yes
No
Don't Know
Father
Yes
No
Don't Know
8. Are your parents: (Check all that apply)
Married
Divorced
Father Remarried
Mother Remarried
9. Was your Father...
Passive
Strong
Indifferent
Absent
10. Was your Mother...
Passive
Strong
Indifferent
Absent
11. Did you have a happy childhood?
Yes
No
Somewhat
12. Do you have trouble giving or receiving love?
Yes
No
Somewhat
13. Were you kept in Foster Care?
Yes
No
14. Were you rejected by parents/peers?
Yes
No
If you answered "Yes" above, please explain.
15. Were you rejected by spouse/lover?
Yes
No
If you answered "Yes" above, please explain.
16. Were you cursed by parents/peers?
Yes
No
If you answered "Yes" above, please explain.
17. Have you participated, at any time in your life, in any of the following Occult Practices? Check all that apply.
Acupuncture (Ancient Chinese or any other type/form)
Astral Projection
Astrology/Horoscopes
Automatic Writing/Painting
Bloody Mary
Channeling
Crystals
Crystal Balls/Divining Devices
Curses
Fortune Telling
Incantations
Light as a Feather
Magic (white/black)
Ouija Board
Palm Reading
Runes
Seances
Scrying
Sorcery
Spells
Table Tipping
Tarot Cards
Vows & Oaths (secret)
Witchcraft/Wicca
Water Witching/Dowsing
Other...
If you answered "Other" above, please explain.
18. Have you participated, at any time in your life, in any of the following New Age/Psychic Practices? Check all that apply.
Auras
Ascended Masters
Biofeedback
Biorhythm Charts
Clairvoyance/Precognition
Clair-audience
Feng Shui
Fire-walking
Healing Magnetism/Energy Distribution
Hypnosis
I Ching
Levitation
Meditation (Eastern)
Mantras & Chants
Materializations
Mind Control
Numerology
Parapsychology
Past Life Therapy
Psychic Consultation
Psychic Healing
Psychic Transference
Psychokinesis
Pyramid Power
Remote Viewing
Spirit Guides
Tantric Yoga
Telekinesis (mentally moving objects)
Telepathy (reading minds or sending thoughts)
Teleportation (moving objects or people)
Trances
Transcendental Meditation
Vedic Philosophy
Voodoo
Yoga
Other...
If you answered "Other" above, please explain.
19. Have you ever read, at any time in your life, any of the following Religious Literature? Check all that apply.
Bhagavad-Gita
Book of Mormon
Book of the Dead
Carlos Castaneda
Course in Miracles
Dianetics
Doctrine & Covenants
Edgar Cayce Books
Gospel of Thomas
Koran
Morals & Dogma
Necronomicon
Pearl of Great Price/Mormonism
Satanic Bible
Science and Health (Christian Science)
Teachings of Buddha
Upanishads
Urantia Book
Other...
If you answered "Other" above, please explain.
20. Have you ever participated, at any time in your life, in any of the following Religious Beliefs, Cults, & Secret Societies? Check all that apply.
Anthroposophical Society
Atheism / Agnosticism
Aryan Nations
Bahai'ism
Buddhism/Zen
Children of God
Church of Satan
Church Universal and Triumphant
DeMolay (Young Male Freemasons)
Druids/Celtic Religions
Eastern Star (Female Freemasons)
Eckankar
Est/The Forum
Hare Krishna
Hinduism
Islam
Jehovah's Witnesses
Kabbalism
Ku Klux Klan
Freemasonry
Gnosticism
Mormonism
Macumba/Umbanda
Mythology
Nation of Islam
Nichiren Shoshu
Palo Mayombe
Odinism
Paganism
Rainbow Girls
Rastafarianism
Reincarnation
Roots
Rosicrucianism
Santeria
Satanism
Science of Mind
Scientology
Spiritism
Swedenborgianism
Taoism
Theosophy
Unification Church (Moonies)
Unity
Voodoo
Way International
Other...
If you answered "Other" above, please explain.
21. Do you currently, or have you ever had any of the following Physical Health Issues?
Arthritis
Cancer
Chronic Fatigue Syndrome
Colitis
Crohns
Diabetes
Epilepsy
Fibromyalgia
Heart Disease
High Blood Pressure
Infertility
Post Traumatic Stress Disorder
Sleep Apnea
Other Health Issues...
If you checked any of the boxes above, please list each one on a separate line and give more details.
22. Do you or a family member currently have, or have ever had any of the following Mental Health Issues? Check all that apply.
ADD/ADHD
Anxiety Disorder
Autism
Bipolar
Borderline
Depression
OCD (Obsessive Compulsive Disorder)
Panic Attacks
Phobias (if yes please list each)
MPD/DID (multiple personalities)
Schizophrenia
Other Mental Disorders...
If you checked any of the boxes above, please list each one on a separate line and give more details
23. List ALL medications you are currently taking. (Note - If you are not currently on any prescription medication, just type "N/A" in the box)
24. Have you recently, or ever received a Psychiatric or Psychological Diagnosis?
Yes
No
If you answered "Yes" above, please explain in detail.
25. Have you ever seen a Psychologist?
Yes
No
If you answered "Yes" above, please explain in detail.
26. Have you ever seen a Psychiatrist?
Yes
No
If you answered "Yes" above, please explain in detail.
27. Have you ever received "Electrical Shock Treatment"?
Yes
No
If you answered "Yes" above, please explain in detail.
28. Do you ever have feelings of guilt?
Yes
No
If you answered "Yes" above, please explain in detail.
29. Do you have terrifying seizures of panic or other abnormal fears?
Yes
No
If you answered "Yes" above, please explain in detail.
30. Have you ever acted like a child since becoming an adult?
Yes
No
If you answered "Yes" above, please explain in detail
31. Do you experience loss of time and sometimes don't remember what happened?
Yes
No
If you answered "Yes" above, please explain in detail.
32. Have you experienced night paralysis?
Yes
No
If you answered "Yes" above, please explain in detail.
33. Are portions of your life missing from memory?
Yes
No
If you answered "Yes" above, please explain in detail.
34. Do you currently, or have you ever had any of the following? (Check all that apply)
Anxious
Depressed
Doubt
Fearful
Inferiority
Insecurity
Lonely
Low Self-Esteem
Nightmares
Stressful
Self-Condemnation
Self-Hate
Self-Punishment
Suspicious
Worried
Worthless
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
35. Do you have any of the following Anger Issues?
Bitterness
Envy
Emotional Abuse
Frustration
Hatred
Jealousy
Physical Abuser
Physical Abuse Victim
Strife
Rage
Revenge
Unforgiveness
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
36. Do you have any of the following Death Issues?
Abortion (You/Spouse/Other)
Intent to Harm Others
Murder
Thoughts of Self-Harm
Self-Harm
Cutting
Suicide Attempt(s)
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
37. Do you have any of the following Abberational Behaviors?
Anxiety Attacks
Anorexia
Bulimia
Compulsive Spending
Picking
Tics
Shoplifting
Tourette's Syndrome
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
38. Do you have any of the following Addictions?
Alcoholism
Drugs
Food
Gambling
Prescription Drugs
Sleep Aids
Sex
Tobacco
Pornography
Masturbation
Workaholism
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
39. Have you ever had an issue with, or personally been convicted of any of the following Criminal Activity?
Arrested
Imprisoned
Embezzlement
Rape
Selling Illegal Drigs
Purchasing Illegal Drugs
Vandalism
Violent Acts
Sexual Offending
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
40. Check ALL that applies ot your personal Sexual History.
Adultery
Bestiality
Internet Chat Room Sex
Phone Sex
I was Sexually Molested
I Sexually Molested Someone
Homosexuality
Lesbianism
Masturbation
Lustful Thoughts
Necrophilia
Perverted Sex
Promiscuity
Pornography
Bi-Sexuality
Cross-Dressing
Prostitution
I was Raped
I Raped Someone
Sadomasochism
Stripping
Transvestism
Exposing
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
41. List any episodes of Abuse, Trauma, Major Accidents, or any other events that deeply affected you. (Give details in appropriate "age" spaces below)
Events from age 0 to 5
Events from age 5 to 10
Events from age 10 to 15
Events from age 15 to 20
Events after 20
42. Have you ever participated in any of the following Demonic Activity?
Anti-Christ Obsessions
Blasphemous Thoughts
Curses placed on you/family
Deny Jesus is God
Deny the existence of Satan or demons
Desire to curse God/Christ
Desire to renounce God/Christ
Hostility to/rejection of God
Pact with the devil
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
43. Have you ever experienced any of the following Demonic Manifestations?
Alien Abduction
Change in Voice
Clawing Inside
Confused Thought(s)
Defile Holy Objects
Convulsions/Seizures
Eyes Turn Red when Angry
Fear Anointing Oil
Fear Holy Water
Spoken
Feel a Presence
Foaming at the Mouth
Hearing Voices or Hissing Sounds
Inability to Move or Speak
Mood Changes
Near-Death Experience(s)
Obscene Outbursts
Out-of-Body Experience(s)
Poltergeists
Possessed by Living Person
See Dark Shapes or Shadows
See Demons
See Fairies
See Ghosts or Apparitions
See Monsters
See Nature Spirits
Spirit Posession
See Visions
Smell Strange Odors
Sudden Sleepiness
Thoughts Invaded
UFO Sightings
Unable to Pray
Unable to Read the Bible
Unexplained Accidents
Unknown Language
Unusual Lights
Unusual Sounds
Unusual Strength
Voices of Dead Heard
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
44. Have you ever experienced any of the following Abnormal Demonic Activity?
Succubus (demonic sexual intercourse with a female spirit)
Incubus (demonic sexual intercourse with a male spirit)
Feeling cold or having the room become very cold
Altered states of consciousness without alcohol/other drug
Feel like external force affects/has power over you
Feel like you're in or seeing a heavy mist/fog
Unexplained electronic/mechanical equipment malfunction
Feelings of pressure on chest/feelings of suffocation
Bites, Scratches, or other physical attacks on your body
Vomiting/Coughing up phlegm in response to prayer
Feelings of being choked/unable to breathe when praying
Hearing growling sounds inside your head or body
Having feelings controlled by someone or something outside of you
Fear of, mocking of, revulsion toward Christian symbols, objects, music etc
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
45. Have you ever heard voices or had thoughts that:
Condemn you severely
Blaspheme God, Jesus of Nazareth, the Holy Spirit, or Christians
Suggest or Urge Illegal, Immoral, or Destructive Activities
Drive you to Commit Suicide, Homicide, or Abortion
Compel you to commit Sexual Assaults, or Perverse Sexual Acts on others
Speak against Christian Pastors, Counselors, Ministers, or Leaders
Other...
If you checked any of the boxes above, please list each on a separate line and explain in detail.
46. Is there anything else that filling out this profile has brought to your mind, or anything related to an issue above that you feel is significant to your spiritual goals and welfare?
47. After reviewing all the above, what have you learned about yourself that you did not realize before filling out this profile?
48. Were there any surprises or unexpected issues in your life that you had not previously recognized, and that you now see as critical to your spiritual progress?
49. After answering these questions, in what way do you understand your spiritual condition better?
50. After completing this profile, what would you say is the most serious area of your life that needs spiritual improvement?
51. Based on the above, what areas of concern would you first like to address?
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