St. Basil OCIA Interest Form
Full Legal Name
*
First Name
Last Name
Middle Name (if applicable)
Maiden Name (if applicable)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Male/Female
Male
Female
Father's Full Name
Mother's Full Name (Maiden)
Place of Birth (City/State)
Birthday
*
-
Month
-
Day
Year
Date
Occupation
Baptism
Have you been baptized?
*
Yes, in a Christian Church that isn't Catholic
Yes, in the Catholic Church
No
Not sure
Name of Catholic Church you were baptized in?
Church City/State
What Sacraments have you received?
Reconciliation/Penance
First Communion
Confirmation
What denomination?
Anglican
Baptist
Lutheran
Methodist
Nondenominational
Orthodox
Pentecostal
Reformed/Presbyterian
Other
Date or Approximate Age when you were Baptized
Name of Church
Church City, State
What do you know about your possible Baptism?
Marital Status
Marital Status
*
Single, Never Married
Living Together
Engaged
Married
Married, Separated
Divorced, Not Remarried
Divorced, Remarried
Widowed, Not Remarried
Widowed, Remarried
Petitioned for Annulment
Annulled, Not Remarried
Annulled, Remarried
Spouse Name
Spouse Religion (if none say N/A)
Wedding Date
-
Month
-
Day
Year
Date
Wedding Location (Place and Location)
(i.e. courthouse, or name and city of church, or venue name)
Is your current marriage your first marriage?
Yes
No
Is your current marriage your spouse's first marriage?
Yes
No
Is this your first divorce?
Yes
No
Please explain where you are at in the annullment process and if you need help.
Fiancé Name
Fiancé Religion (if none say N/A)
Do you have a wedding date set?
Yes
No
Wedding Date
-
Month
-
Day
Year
Date
Do you have children?
Yes
No
Children Names and Ages
Tell us about why you are interested in learning more about the Catholic faith.
Submit
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