OCIA intake form
Please complete this form and Ben Bongers will respond as soon as possible.
Full legal name (including fill middle name)
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What name do you like to be called?
Street address
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
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example@example.com
Date of birth
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City and state of birth
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Country of Birth
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Have you been baptized? If so, in which denomination?
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We will need a PROOF OF BAPTISM (Baptismal Certificate, letter from former church, etc.) within the first month of joining OCIA
If you have been baptized, what is the name of the Church and its address?
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Are you currently Catholic seeking Confirmation?
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Please Select
Yes
No
Are you or have you ever been married?
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Please Select
Yes
No
If married, spouse's first name
If married, where were you married and what is the address?
Who were you married by: Catholic Clergy, Christian Minister, Licensed Officiant, or Civil Agent?
We will need any and all MARRIAGE LICENSES within the first month of joining OCIA.
Do you have children?
Name and age of child 1
Name and age of child 2
Name and age of child 3
Name and age of child 4
Name and age of child 5
Have you ever been divorced?
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Please Select
Yes
No
If you have been divorced, have you had an annulment?
Please Select
Yes
No
If you are single, are you engaged
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Please Select
Yes
No
What religion is your fiancée?
Has your fiancée been married before?
Please Select
Yes
No
Are you separated from your spouse?
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Please Select
Yes
No
Are you widowed?
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Please Select
Yes
No
Mother's full name and Maiden name
Mother's religion
Father's full name
Father's religion
Occupation/employer
Do you have a sponsor in mind? If so, who? Please include their telephone number and email address.
Briefly state what is drawing you to the Catholic faith
Questions/comments?
By submitting this form I do understand and authorize that my face and person may be videotaped and distributed as a part of the Order of Catholic Initiation of Adults (OCIA) class and all of its subsidiary uses. The parish holds the right to take, copy, edit, alter, exhibit, publish, and distribute on all media formats. I agree that as a part of this class i will not be compensated for the use of my image, voice, or by any other representation. I do not and will not hold St. Therese Parish liable in the reproduction of my person. I also authorize, in conjunction with the OCIA of Holy Spirit Parish, my name may be published in periodicals, bulletins, websites, media, or social media outlets.:
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Please type "I AGREE."
Submit Form
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