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Adult Faith Formation Intake Form
Information on this form is held in confidence and is not shared without your permission.
Today's Date
/
Month
/
Day
Year
First Name
*
Middle Name
Last Name
*
Maiden Name (if applicable)
Date of Birth
*
/
Month
/
Day
Year
Age
*
Place of Birth
*
City, State, Country
Name of Father
*
Name of Mother
*
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I. CONTACT INFORMATION
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone (Home)
Cell/Mobile Phone
*
Occupation
*
Email
*
example@example.com
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II. RELIGIOUS HISTORY
1. What, if any, is your present religious affiliation?
2. Have you ever been baptized?
*
Yes
No
I am not usre
If, you answered"Yes" to Question 2, plase provide the following information:
(a) In what denomination were you baptized?
(b) Date of when you were baptized
/
Month
/
Day
Year
(c) Place of Baptism (name of church)
Address, if known of place of baptism:
City, State & Country
3. If you were baptized as a Catholic, check the sacraments you have already received
Reconciliation (Confession)
Eucharist (First Communion)
Confirmation
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III. Current Marital Status
Check the appropriate statement(s) below and provide any information requested beneath each statement.
*
1. I have never been married.
2. I am engaged to be married.
3. I am married.
4. I am married, but separated from my spouse.
5. I am divorced.
6. I am divorced, but have remarried.
7. I am a widow/ widower and have not remarried since my spouse's death.
8. I am not married, but live with my partner.
If you are engaged to be married, please answer the following questions.
a.) Your Fiancé(e)'s Name
b.) Your Financé(e)'s current religious affiliation (if any)
c.) Have you been married before?
This is my first marriage.
I have been married before.
Please answer the following if you have been married before.
I have begun the annulment process.
I have received an annulment.
d.) For your fiancé(e)
This is his/ her first marriage.
My fiancé(e) has been married before.
Please answer the following question if your fiancé (e) has been married before.
They have begun the annulment process.
They have received an annulment.
If you are married, please answer the following questions.
a.) What is our Spouse's Name?
b.) Your Spouse's Current Religious Affiliation (if any)
c.) Is this your first marriage?
This is my first marriage.
I have been married before.
Please answer the following if you have been married before.
I have begun the annulment process.
I have received an annulment.
d.) For your spouse
This is my spouse's first marriage.
My spouse has been married before.
Please answer the following question if your spouse has been married before.
They have begun the annulment process.
They have received an annulment.
e.) Date of Marriage
/
Month
/
Day
Year
f.) Place of Marriage
g.) Officiating Authority of Marriage
Civil government, non- Christian minister, Christian minister, Catholic cleric)
If you are married, but separated from your spouse, please answer the following questions.
a.) Date of Marriage
/
Month
/
Day
Year
b.) Place of Marriage
(Include locality (town, city, county, etc), region (state, province, territory, etc), and country
c.) Officiating Authority of Marriage
Civil government, non- Christian minister, Christian minister, Catholic cleric)
If you are divorced, please answer the following questions.
Have you annulled your marriage?
I have begun the annulment process.
I have received an annulment.
If you are divorced but have remarried, please answer the following questions.
Have you annulled your previous marriage?
I have begun the annulment process.
I have received an annulment.
a.) Date of Marriage
/
Month
/
Day
Year
b.) Place of Marriage
(Include locality (town, city, county, etc), region (state, province, territory, etc), and country
c.) Officiating Authority of Marriage
Civil government, non- Christian minister, Christian minister, Catholic cleric)
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IV. FAMILY INFORMATION
List the name(s) of any children or other dependents (e.g., Daughter-Jane; Stepson-John)
1. Child or Dependent Full Name
Relationship to you
Age
2. Child or Dependent Full Name
Relationship to you
Age
3. Child or Dependent Full Name
Relationship to you
Age
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V. GENERAL QUESTIONS
1. For persons that were baptized Catholic:
Are you interested to learn more about the Catholic Faith or/ and to receive the Sacraments of the Church?
Learn more about the Faith
Receive the Sacraments
Both
Have you received any type of religious education as a child and/or as an adult?
Yes
No
If you have received any type of religious education, please explain:
2. For all non- baptized persons:
Have you had any contact with the Catholic Church to date?
Yes
No
Do you have any questions or concerns about the Catholic Church?
Yes, I have questions.
Yes, I have concerns.
No
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 I want to join the Catholic Church.
There is a suggested tuition of $50.00
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