RCIA Application Form
Title
First
Last
Suffix
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
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Algeria
American Samoa
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Anguilla
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Aruba
Australia
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Azerbaijan
The Bahamas
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Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
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Zimbabwe
Other
Country
Date of Birth:
Please select a month
January
February
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Month
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1
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31
Day
Please select a year
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2000
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1996
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1994
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1992
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1982
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1980
1979
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1975
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1967
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1963
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1958
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1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
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1942
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1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Place of Birth:
Father's Full Name:
First Name
Last Name
Mother's Full Name (include Maiden Name):
First Name
Last Name
Do you have children?
Please Select
Please select...
Yes
No
Are you baptized?
Please Select
Please select...
Yes
No
If Catholic, have you received the sacrament of Confirmation?
Please Select
Please select...
Yes
No
N/A
If Catholic, have you received the sacrament of First Communion?
Please Select
Please select...
Yes
No
N/A
Please check all that apply:
Single
Engaged
Married
Separated
Divorced
Widowed
When you were a child, was your family religious?
Please Select
Please select...
Yes
No
Sort of
Don't know
Have you ever participated in another church or religion as an adult?
Please Select
Please select...
Yes
No
If you wish, describe any other people, places, objects or events in your life that you would identify as sacred.
Describe any experiences of serving others, whether among friends, family, at work or as a volunteer, that have affected your outlook on life.
Do you experience God in your life?
Please Select
Please select...
Yes
No
Not Sure
What has been your experience with prayer? Please mention any of the various styles or ways of prayer you have tried. If you currently have a regular practice of prayer, please describe how you pray now.
Are you familiar with the Bible?
Please Select
Please select...
Yes
No
Sort of
Do you have a clear notion of who Jesus Christ is?
Please Select
Please select...
Yes
No
Sort of
Are you familiar with the Catholic Church?
Please Select
Please select...
Yes
No
Sort of
What or who has prompted you to seek religious instruction at this time? what are you looking for in coming to the Catholic Church? Please be specific.
What is your level of interest in the Roman Catholic Church?
Please Select
Please select...
At this time I am just looking. I want to know what Catholics believe.
I am attracted to Catholic Christianity and am considering becoming Catholic.
I am almost certain I want to join the Catholic Church.
I am Catholic and want to refresh my knowledge/faith.
Other.
Please explain:
Do you know any Catholics in this Parish?
Please Select
Please select...
Yes
No
Do you know anyone in the parish who would like to be your sponsor?
Please Select
Please select...
Yes
No
What you presently value in your life?
Is there any other way we might be of help to you? Do you have any specific questions, special needs or concerns at this time? Please feel free to write down any other information that you think would help our pastoral staff give you guidance you need to help your spiritual journey.
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