Your name
Today's Date
/
Month
/
Day
Year
Date
Your date of birth
/
Month
/
Day
Year
Date
Your place of birth. Include town/city, region (state, province, territory, etc.), and country (if born outside of the USA)
Father's Name
Father's religion
Mother's Name
Mother's religion
Your address (Street, Appt., City, State, & ZIP)
Your Phone Number
-
Area Code
Phone Number
Email
example@example.com
What, if any, is your present religious affiliation?
Have you ever been baptized?
Yes
No
I am not sure
In what church/denomination were you baptized?
Date or approximate age at which you were baptized:
Your baptismal name (if different from current name):
Place of baptism (including name of church)
Address of church of baptism (if known)
Location of place of baptism (if somewhere other than a church)
If you were baptized as a Catholic, please check the sacraments which you have already received:
Penance (Confession)
Eucharist (First Holy Communion)
Confirmation
Church & Date of your First Penance (Confession)
Church & Date of your First Holy Communion
Church & Date of your Confirmation
Is there any Eastern Catholic of Eastern Orthodox membership in your family background?
Yes
No
If so, please describe:
Have you ever been accepted as a catechumen or candidate for full communion in the Catholic Church?
Yes
No
If yes, when?
If yes, where?
Your current marital status:
I have never been married.
I am engaged to be married.
I am married.
I am married but separated from my spouse.
I am divorced and I have not remarried.
I am a widow/widower and have not remarried since my spouse's death.
Your Fiancé(e)'s name:
Your Fiancé(e)'s current religious affiliation (if any)
For you:
This is my first marriage.
I have been married before.
For your Fiancé(e):
This is his/her first marriage
My Fiancé(e) has been married before
Your spouse's name:
Date of marriage to your current spouse:
(b) Your Spouse's Current Religious Affiliation (if any):
Place of marriage to your current spouse (include church/courthouse, town, county, state, etc). If outside of the USA, please include region/province/territory and country)
Officiating Authority of Marriage (civil government, non-Christian minister, Christian minister, Catholic clergy, etc.):
For you:
This is my first marriage.
I have been married before.
For your spouse:
This is my spouse's first marriage.
My spouse has been married before.
For teens and children: what school do you attend?
Is anyone else in your family Catholic? Please list.
Who or what has led you to want ot know more about the Catholic Faith?
What types of religious education have you received, as a child and as an adult?
What contact or experience have you had with the Catholic Church to date?
What are some questions or concerns you have about the Catholic Church?
Do you anticipate any conflicts with the RCIA schedule? Please describe
Other comments and questions:
At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church?
I need much more information about the Catholic Church before I would consider joining.
I am considering joining, but I am still unsure about it.
I am fairly sure that I would like to join, but I still need some time to study and pray about it.
I am fairly sure that I want to join the Catholic Church.
Submit
Should be Empty: