Adult RCIA Information Form
Name
First, Middle, Last Name
Maiden Name (if applicable)
Date of Birth and Place of Birth
Mother and Father Names:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Primary Email
example@example.com
occupation
What, if any, is your present religious affiliation?
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Have you been baptized?
Yes
No
I am not sure
In what denomination were you baptized?
Date of your approximate age when you were baptized:
Baptismal name (if different from current name)
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Place of Baptism (name of church/denomination/ address):
If you were baptized as a Catholic, check those sacraments you have already received:
Penance (Confession)
Eucharist (First Holy Communion)
Confirmation
Have you been married?
Yes
No
I am engaged
First Marriage
I have been married before.
Fiancé Name and Current Religious affiliation
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For your fiancé
This is his/hers first marriage
My fiancé(e) has been married before
I am married. Your spouse's name: Religious Affiliation (if any)
For you,
This is my first marriage
I have been married before
For your spouse
This is my spouses first marriage
My spouse has been married before
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
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Family Information ( list name and age of any children and other dependents( e.g daughter- Jane; stepson, John )
What or who had led you to want to know more about the Catholic Faith?
Please describe the type of religious education you have recived 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? (Please select one)
I need 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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