Your General Information
Name
*
Mr.
Mrs.
Miss
Ms.
Prefix
First Name
Middle Name
Last Name
Suffix
Maiden Name
If applicable
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Birth Location
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Name of Father
First Name
Last Name
Name of Mother
First Name
Last Name
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Your Contact Information
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Primary Phone Number
*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Email
*
example@example.com
Sponsor/Godparent Full Name
*
First Name
Last Name
Sponsor/Godparent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Your Religious Information
What, if any, is your present religious affiliation?
*
Have you ever been baptized?
*
Yes
No
I'm not sure
If you answered “Yes” to Question 2, please provide the following information:
In what denomination were you baptized?
*
Date or your approximate age when you were baptized:
*
Baptismal name (if different from current name):
*
Place of Baptism (Name of church/location):
*
Church Address (if known):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you were baptized as a Catholic, check those sacraments you have already received:
Reconciliation
Eucharist
Confirmation
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Relationship Information
Check the appropriate statement below.
*
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's Name
*
First Name
Last Name
Your Fiancé’s Current Religious Affiliation (if any):
*
For You:
*
This is my first marriage.
I have been married before.
For Your Fiancé:
*
This is his/her first marriage.
My fiancé has been married before.
Your Spouse's Name
*
First Name
Last Name
Your Spouse's Current Religious Affiliation (if any):
*
For You:
*
This is my first marriage.
I have been married before.
For Your Spouse:
*
This is his/her first marriage.
My spouse has been married before.
Date of Marriage
*
-
Month
-
Day
Year
Date
Place of Marriage (Church, City, State, Country)
*
Officiating Authority of Marriage (Civil government, non-Christian minister, Christian minister, Catholic Cleric)
*
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Family Information
Do you have any children/dependents?
*
Yes
No
How many children/dependents do you have?
*
Please Select
1
2
3
4
5
6
Child 1's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
Child 2's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
Child 3's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
Child 4's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
Child 5's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
Child 6's Name, Relationship, and Age
*
(e.g. Daughter—Jane, Age 5; Stepson—John, Age 8)
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General Questions
What or who has led you to want to know more about the Catholic Faith?
*
Please describe the types of religious education you have received as a child and as an adult.
*
What contact have you had with the Catholic Church to date?
*
What are some of the questions or concerns you have about the Catholic Church?
*
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.
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