Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Father's Name *

First Name

Last Name

Mother's Maiden Name *

First Name

Last Name

OCIA Sponsor Name

First Name

Last Name

Baptism *

Unbaptized

Baptized Catholic or in other Christian ecclesial community

Date of Baptism

MM

DD

YYYY

Marital Status *

Single

Engaged to be Married

Married

Widow/Widower

Divorced

Separated

Common-law/Cohabitation (living together with boyfriend or girlfriend)

Date of Marriage

MM

DD

YYYY

At this point in time, what best describes your thoughts/feelings about joining the Church? *

I need much more information about the Roman Cahtolic 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 need some time to study and pray about it.

I am very sure that I want to join the Roman Catholic Church