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  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Middle Name REQUIRED Please fill out this field. Please enter valid data.
  • Maiden Name (if applicable) Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Place of Birth REQUIRED

    include locality (town, city, county, etc.), region (state, province, territory, etc.), and country

    Please fill out this field. Please enter valid data.
  • Name of Father REQUIRED Please fill out this field. Please enter valid data.
  • Name of Mother REQUIRED Please fill out this field. Please enter valid data.
  • Contact Information
    • Mailing Address REQUIRED Please fill out this field. Please enter valid data.
    • City REQUIRED Please fill out this field. Please enter valid data.

      State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

      Zip REQUIRED Please fill out this field. Please enter a zip code.
    • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
    • Occupation REQUIRED Please fill out this field. Please enter valid data.
    • Email REQUIRED Please fill out this field. Please enter valid data.
  • Religious History
    • 1. What, if any, is your religious affiliation? REQUIRED Please fill out this field. Please enter valid data.
    • 2. Have you ever been baptized? REQUIRED Yes No I am not sure Please fill out this field.
    • If you answered "Yes" to Question 2, please provide the following information:
    • In what denomination were you baptized? Please enter valid data.
    • Date or your approximate age when you were baptized: Please enter valid data.
    • Baptismal name (if different from current name): Please enter valid data.
    • Place of Baptism (name of church/denomination): Please enter valid data.
    • Address, if known: Please enter valid data.
    • Location, if known:

      include locality (town, city, county, etc.), region (state, province, territory, etc.), and country

      Please enter valid data.
    • 3. If you were baptized as a Catholic, check those sacraments you have already received: Penance (Confession) Eucharist (First Communion) Confirmation
  • Current Marital Status
    • Choose the appropriate statement below REQUIRED (Select One) I have never been married. 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 Please fill out this field.
    • If you are engaged to be married, please provide the following information:
    • Your Fiancé(e)'s Name: Please enter valid data.
    • Your Fiancé(e)’s Current Religious Affiliation (if any): Please enter valid data.
    • For you: This is my first marriage. I have been married before.
    • For your fiancé(e): This is his/her first marriage. My fiancé(e) has been married before.
    • If you are married, please provide the following information:
    • Your Spouse's Name: Please enter valid data.
    • Your Spouse’s Current Religious Affiliation (if any): Please enter valid data.
    • For you: This is my first marriage. I have been married before.
    • For your spouse: This is my spouse's first marriage. My spouse has been married before.
    • Date of Marriage Please enter valid data.
    • Place of Marriage

      include locality (town, city, county, etc.), region (state, province, territory, etc.), and country

      Please enter valid data.
    • Officiating Authority of Marriage:

      (civil government, non-Christian minister, Christian minister, Catholic cleric)

      Please enter valid data.
  • Family Information
    • List the name(s) of any children or other dependents
  • General Questions
    • 1. What or who has led you to want to know more about the Catholic Faith? REQUIRED Please fill out this field.
    • 2. Please describe the types of religious education you have received, as a child and as an adult. REQUIRED Please fill out this field.
    • 3. What contact have you had with the Catholic Church to date? REQUIRED Please fill out this field.
    • 4. What are some of the questions or concerns you have about the Catholic Church? REQUIRED Please fill out this field.
    • 5. 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? REQUIRED I need much 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. Please fill out this field.

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