ST. JUNIPERO SERRA HOUSE OF FORMATION DIOCESE OF SAN BERNARDINO

DIOCESE OF SAN BERNARDINO

Application for Admission to St. Junipero Serra House of Formation
GENERAL INFORMATION
Name*

First NameMiddle InitialLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Place of Birth*
U.S. Social Security Number
Or, Visa Type
ID #
Mobile*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
E-mail address*
example@example.com
Do you have any medical condition or handicap that requires special attention, drugs or equipment, or facility accommodations that would affect your attendance?*

YesNo
If Yes, please specify:
BACKGROUND
FATHER'S INFORMATION*

First NameMiddle NameLast Name
Place of Birth*
Living*

YesNo
If living:

Street Address

Street Address Line 2

City / State / Zip CodeState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Religion*
Highest Academic Year Completed
Occupation*
Marital Status*
If deceased, cause of death
Year of death
Age at death
MOTHER'S INFORMATION*

First NameMiddle NameLast Name
Place of Birth*
Living*

YesNo
If living:

Street Address

Street Address Line 2

City / State / Zip codeState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Religion*
Highest Academic Year Completed
Occupation*
Marital Status*
If deceased, cause of death:
Year of death
Age at death

BROTHERS AND SISTERS

	Name	Age	Occupation	Marital Status	Practicing Catholic (Yes or No)
1
2
3
4
5
6
7

Please check box if more than seven
Do you have any relatives in the priesthood or religious life?*

YesNo

If Yes, please list:

	Name	Order
1
2
3
4
5

Have you ever dated?*

YesNo
If yes, how old were you when you had your first date?
Have you ever been engaged?*

YesNo
If yes, how old were you?
Have you ever married (in a church, civilly or by common law)?*

YesNo

If yes, please fill in the information below:

	To whom	Date	Place	Before whom (Priest, JP, Minister, etc)
1

Have you received a civil divorce?*

YesNo
Have you received a church annulment?*

YesNo

If yes, please fill in the information below:

	Diocese	Date of Annulment	Protocol Number
1

Is your former spouse deceased?*

YesNo
Do you have any children?*

YesNo
If yes, how many? and what ages?
What are your responsibilities toward your children?
Do you have a relative or other dependent for whom you are financially and morally responsible?*

YesNo
If Yes, please explain:
EDUCATION

HIGH SCHOOL/RELIGIOUS EDUCATION*

	institution	City/State	Year of Attendance From - To	Date Graduated/Expected
1
2
3

If you did not attend Catholic schools, please indicate the extent of your religious education (Parish, CCD, or School of Religion)

UNDERGRADUATE LEVEL / COLLEGE

	institution	City/State	Year of Attendance From - To	Degree & Major	Date Graduated/Expected
1
2
3

GRADUATE LEVEL / MASTER DEGREE

	institution	City/State	Year of Attendance From - To	Degree & Major	Date Graduated/Expected
1
2
3

Please, list any specific academic honors or awards or honor society memberships:

Give your approximate grade point average (GPA)*

	High School	Undergraduate Level / College	Graduate Level / Master Degree
GPA

Did you fail any courses?*

YesNo
If Yes, please specify:
What studies did you like best?*
What studies did you like least?*
Extra-curricular activities, social and athletic:
Have you ever been denied admission to a school?*

YesNo
Have you ever been suspended, dismissed or forcibly withdrawn from an institution for non-academic reasons?*

YesNo
If your major was not Philosophy, indicate which Philosophy courses you have had
In what areas or skills of education do you have special training or qualifications
Are you requesting to transfer college credits?

YesNo
Approximate semester hours?
From what school(s)
Are you requesting to transfer graduate theology credits?

YesNo
Approximate semester hours?
From what school(s)
What foreign languages have you studied and for how long?
Language:
Skills:

SpeakWrite
Language:
Skills:

SpeakWrite
Language:
Skills:

SpeakWrite
MILITARY SERVICE
Are you registered for the Selective Service?*

YesNo
Selective Service Number
Have you served in the U.S. Military?

YesNo
Are you a U.S. Military Veteran?

YesNo
Do you have educational benefits?

YesNo
What Chapter?
Branch of Service
Date of Enlistment

MonthDayYear
Rank at Discharge
Date of Discharge

MonthDayYear
Type of Discharge
Reserve Status:
WORK EXPERIENCE

List any significant work, professional or career related experiences. Start with the most recent employment:

List any significant work, professional or career related experiences. Start with the most recent employment

	Employer	Address	Position	Approximate Dates
1
2
3
4
5

CONSENT TO CONTACT EMPLOYER / OTHER WORK
May we contact your former employers?

YesNo
Have you been fired from a job?

YesNo
If yes, please explain:
EXPERIENCE VOLUNTEERING
Volunteer work and activities in which you have participated
Do you belong to any professional/social organizations?

YesNo
Describe if "yes"
TIME MANAGEMENT
About how much free time do you have from school and/or work? How do you spend it? Include hobbies, etc.*
What type of books do you prefer reading?
List some book titles you have read recently
Which streaming shows/programs do you watch?
Do you have a presence in any social media platforms?*

YesNo
If Yes, what social media do you use to share content, interact with others, etc.?
FAITH BACKGROUND

SACRAMENTS*

	CHURCH	CITY	STATE	COUNTRY
BAPTISM
FIRST COMMUNION
CONFIRMATION

Attach an official baptism certificate, with all notations, issued within the last six months by Church of record. *

Cancelof
Attach official Certificates of First Communion and Confirmation*

Cancelof
Home Parish Name*
Address*

Street Address

Street Address Line 2

City / State / Zip CodeState / Province

Postal / Zip Code
Have you ever belonged to a church or religious body other than the Roman Catholic Church?

YesNo
If yes, what denomination?
Date of reception to the Catholic Church

MonthDayYear
Date

Indicate frequency of the following for yourself and your parents*

	Yourself	Father	Mother
Mass attendance:
Reconciliation

Have you ever been away from the Church for any period of time?*

YesNo
If Yes, for how long?
When did you return to the Catholic Church?
Do you have a Spiritual Director?*

YesNo
How long and how often have you met with the Director?
CHURCH INVOLVEMENT
List the ways in which you have been involved in the Church (e.g., server, choir member, lector, Eucharistic Minister, other):

List all the diocese(s) in which you have resided for six months or longer after 14 years of age

	Diocese
1
2
3

Have you applied and NOT BEEN ACCEPTED by a seminary, diocese, religious community, or secular institute?

YesNo

If Yes, please list:

	Name of seminary, diocese, religious community, or secular institute	Date of application
1
2
3

Have you ever BEEN ACCEPTED by a seminary, diocese, religious community, or secular institute?

YesNo

If Yes, please list:

	Name of seminary, diocese, religious community, or secular institute	Date of entering	Date of leaving
1
2
3

Did you leave of your own accord or were you asked to leave? Explain why, if applicable:
If you were in formation, were you instituted to the Ministry of Reader or Acolyte or Candidacy?

YesNo

If Yes, please list:

	Place	Month/Day/Year
Ministry of Reader
Ministry of Acolyte
Call to Candidacy

If you were in formation, have you ever bound yourself by oaths, vows or promises?

YesNo
If Yes, specify organization
Date

MonthDayYear
Were they Temporary or Perpetual?
Have they expired or been dispensed?
ABOUT YOUR VOCATION
How old were you when you first thought of becoming a priest?*
Who, besides yourself, contributed most to your choice of this vocation?*
Do your parents approve of your studying for the priesthood?*
What skills, aptitudes and experiences do you have which may be valuable in your ministry as a priest?*
What motivated you to join our Diocese?*
Assuming you are ordained, what kind of assignment would you prefer?*
If you were not become a priest, what other careers would you consider?*
What is your understanding of Obedience to your Bishop?*
What is your understanding of Priestly Celibacy?*
What apprehensions do you have about your decision to be a diocesan priest?*
What are some of the duties which priests perform that you find appealing?*
RELEASE OF INFORMATION
The policy of the Roman Catholic Diocese of San Bernardino is that all information regarding seminarians be held in strictest confidence by the Bishops, Director, Rector, Seminary Board and diocesan appointed psychologists who are permitted access. It is the responsibility of the Director of Vocations / Seminarians to maintain that confidence and to personally approve the release of any information as allowed through this form. Information from my file may not be released to any other party without my written consent.

I recognized that the information requested is provided in confidence and hereby grant the release of: Academic transcripts, evaluations, interviews, letters of recommendation, medical records and psychological reports.

I, the undersigned, in light of the above guarantee, acknowledge that said information, which is or will be an official part of my personal files, becomes the property of the Office of Vocations / Seminarians.

I attest that all the information contained in this application and pertinent to any information provided as part of the process is true and complete to the best of my knowledge.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

DIOCESE OF SAN BERNARDINO

GENERAL INFORMATION

BACKGROUND

EDUCATION

MILITARY SERVICE

WORK EXPERIENCE

CONSENT TO CONTACT EMPLOYER / OTHER WORK

EXPERIENCE VOLUNTEERING

TIME MANAGEMENT

FAITH BACKGROUND

CHURCH INVOLVEMENT

ABOUT YOUR VOCATION

RELEASE OF INFORMATION