OCIA Form

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

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address: Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Email Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Birth Date: REQUIRED Please fill out this field. Please enter valid data.

Birth Place REQUIRED Please fill out this field. Please enter valid data.

Place of Employment Please enter valid data.

Mother's Full Name: Please enter valid data.

Father's Full Name Please enter valid data.

Religious Affiliation:

*(If Baptized) WE WILL NEED A COPY OF YOUR BAPTISMAL CERTIFICATE

Were you ever baptized? REQUIRED YES NO Please fill out this field.

If Yes, what denomination? Please enter valid data.

If yes, where? Please enter valid data.

If yes, describe your participation:

Did you ever leave this denomination and join another? YES NO

If yes, which one (s)? Please enter valid data.

If Catholic, were you Confirmed? Yes No

If Catholic, did you receive your First Eucharist? Yes No

Marital Status

Are you presently married? REQUIRED Yes No Please fill out this field.

If Yes:

Was your marriage witnessed by a : Priest Minister Justice of the Peace Other

Were you ever in a prior marriage(s)? Yes No

Was your spouse ever in a prior marriage(s)? Yes No

If yes, did the marriage end in: Death Divorce

If divorce:

Additional Information:

When did you first become interested in the Catholic Church? REQUIRED Please fill out this field.

Do you have relatives or friends in this parish? REQUIRED Please fill out this field.

What are your interests and hobbies? REQUIRED Please fill out this field.

What are you most desiring from participating in RCIA? REQUIRED Please fill out this field.

Is there any other information that we should know that would help you this year? REQUIRED Please fill out this field.

Saints Mary and Joseph Parish