Name
*
First Name
Last Name
Maiden name (if applicable)
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
*
Occupation
Date of birth
*
MM
DD
YYYY
Place of Birth
*
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Current religious affiliation
*
Have you ever been baptized?
*
In which Christian denomination were you baptized?
Date (or approximate age) baptized
Name of church or parish (city, state)
If you were baptized in the Catholic Faith, which sacraments have you received?
I have never been married
*
I am currently cohabitating with someone in a romantic relationship
*
I am engaged to be married
*
I am married
*
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
*
Previous marriages: Me
Previous marriages: My Spouse/Fiancée
Marriage details
If you answered yes to any of the above, please explain. Include names, dates, locations and other relevant information.
Family Information
List the name(s) of any children or other dependent(s) below (Name, relationship, age):
1. What or who has led you to want to know more about the Catholic faith?
2. Please describe the types of religious education you have received, as a child and as an adult.
3. What contact have you had with the Catholic Church to date?
4. What are some of the questions or concerns you have about the Catholic Church?
5. Currently, which of the following statements best describes your present feelings about the possibility of joining the Catholic Church?
