Extraordinary Minister of Holy Communion Form

Extraordinary Minister of Holy Communion Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
I am a practicing Roman Catholic.
I am at least 16 years old.
I have received the sacraments of Baptism, Confirmation and Holy Eucharist in the Catholic Church.
My commission as an Extraordinary Minister of Holy Communion will be for:
Note: If your EM certification was obtained more than 3 years ago, you will need to retake the class.
I testify by my answers and signature below that I am qualified to serve as an Extraordinary Minister of Holy Communion in the Catholic Church.
Signature
Date

MonthDayYear
Date
Should be Empty: