Becoming Catholic Intake Form
Inquirer Full Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
*
E-mail
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
Date
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
City & State of birth
*
Gender
*
Please Select
Male
Female
N/A
Occupation
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Father's Full Name
*
First Name
Middle Name
Last Name
Father's Religion
Mother's Full Maiden Name
*
First Name
Middle Name
Last Name
Mother's Religion
What brought you to inquire about the Catholic Church and how long have you been curious to know more? What do you hope to gain for yourself?
*
What religious education/exposure/experiences have you had up to this point? (what traditions have you been apart of, what services have you attended, do you currently attend mass etc.)
*
Describe your relationship with God. How do you see God? Do you pray? When and what does that look like to you?
How would you currently describe you right now?
*
I don't want to become Catholic, I am just curious and want to learn more.
1
2
3
4
5
6
7
8
9
I definitely want to become Catholic.
10
1 is I don't want to become Catholic, I am just curious and want to learn more., 10 is I definitely want to become Catholic.
Baptism
Please complete the following section about receiving the sacrament of baptism
Have you been baptized? (Either Catholic or other Christian denomination baptism)
*
No
Yes, Catholic baptism
Yes, other Christian denomination baptism
Date of baptism
-
Month
-
Day
Year
Date
Church of Baptism
Name of Church of Baptism
Street Address
City
State / Province
Postal / Zip Code
Sacrament of Holy Eucharist
Please complete this section if you have received the sacrament of the Holy Eucharist
Have you received the sacrament of the Holy Eucharist?
No
Yes
Date when 1st received Holy Eucharist
-
Month
-
Day
Year
Date
Church of Sacrament
Name of Church of Baptism
Street Address
City
State / Province
Postal / Zip Code
Sponsor Information
A sponsor plays a very important role in the journey of someone interested in becoming a Catholic. A sponsor is a practicing Catholic in good standing with the Church, who accompanies the catechumen or candidate during the rites and period of election, initiation and mystagogy. The sponsor must be willing to participate in the OCIA session and sponsor activities.
Have you already chosen a sponsor?
*
No
Yes
Sponsor Name
First Name
Last Name
Sponsor Phone Number
Please enter a valid phone number.
Sponsor Email
example@example.com
Confirmation Saint
Please complete this section when you have chosen a patron/patroness saint for your Sacrament of Confirmation. You may choose your Baptismal Name, a name from the bible or a canonized saint of the Catholic Church. The saint you choose should reflect a devotion you have to the saint, virtues or gifts to with you aspire or a patron saint of certain gifts that are dear to you. It is recommended to read and learn about several saints and their lives before making your choice. You may choose a saint of either gender. Pray about the saint you are considering and ask the Holy Spirit to guide you in choosing a Confirmation Saint. You can come back to this section when you are ready to choose a saint.
Are you ready to choose a confirmation saint name?
No
Yes
If you have chosen a Confirmation Saint already, please enter it here.
Confirmation Saint Name
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Marital Status
*
Single- Never married
Widowed
Engaged or soon to be engaged
Married- 1st and only marriage
Divorced and engaged to marry again
Divorced and remaining single
Divorced and remarried
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Married
Please complete about your current marriage
Spouse's Name
First Name
Last Name
Spouse's Religion
How were you married?
by a Catholic priest/deacon
a non-Catholic Christian minister
a Justice of the Peace
Other
Please explain why you chose this route to be married:
Has your spouse been previously married?
No
Yes
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Engagement
Please complete this information about your fiance' and your engagement to marry.
Fiancé's Name
First Name
Last Name
Fiancé's Religion
Who do you plan on getting married by?
by a Catholic priest/deacon
a non-Catholic Christian minister
a Justice of the Peace
Other
Do you plan on getting married in the Catholic Church?
Yes
No
Undecided
Please explain why you chose this route to be married:
Anticipated Wedding Date
-
Month
-
Day
Year
Date
Anticipated Wedding Location
Name
Street Address
City
State / Province
Postal / Zip Code
Has your fiancé been previously married?
No
Yes
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Divorce
Please complete this section about your divorce.
Former Spouse 1 that was divorced
First Name
Last Name
Former Spouse 2 that was divorced
First Name
Last Name
How many times has the Former Spouse 1 been married?
How many times has the Former Spouse 2 been married?
Has an annulment been applied for or granted for this marriage?
No
Yes, applied for annulment
Yes, granted an annulment
Unsure
Diocese of annulment
Which diocese was the annulment applied for and/or granted?
Date annulment was applied for
-
Month
-
Day
Year
Date
Date annulment was granted
-
Month
-
Day
Year
Date
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Divorce
Please complete this section about your spouse's or fiance's divorce.
Former Spouse 1 that was divorced
First Name
Last Name
Former Spouse 2 that was divorced
First Name
Last Name
How many times has the Former Spouse 1 been married?
How many times has the Former Spouse 2 been married?
Has an annulment been applied for or granted for this marriage?
No
Yes, applied for annulment
Yes, granted an annulment
Unsure
Diocese of annulment
Which diocese was the annulment applied for and/or granted?
Date annulment was applied for
-
Month
-
Day
Year
Date
Date annulment was granted
-
Month
-
Day
Year
Date
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Please verify that you are human
*
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