RCIA Registration RCIA Information Form Please enter n/a for any fields that do not apply to you. Basic Contact Info First Name * Middle / Mainden Name Last Name * Gender * Female Male Home / Cell Phone * Work Phone * Email Address * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Personal History Place of Work / Occupation * Place of Birth * Date of Birth * Fathers Name * Fathers Religion * Mothers Name * Mothers Religion * Are you currently married? * Yes No Spouse's Name * Spouses Religion * Names & Ages of Children (if applicable) * Are there any previous marriages for you or for your spouse? * Yes No Information on Faith Information Have you ever been baptized? * Yes No In What Year? * Name of Church of Baptism? * What Denomination? * City & State of Church * Please describe your past involvement with other faith communities? I.e. Sunday School, ministries, youth groups * Are you now an active member of another denomination? * Yes No How many years since active involvement in a church? (if any) * Who or what prompted you to come to these inquiry sessions? * What do you hope to gain from these sessions? * Please check topics that most interest you at this point: * Images of God The Catholic Bible Who Is Jesus The Role of Mary The Pope and Bishops The Catholic Mass Confession of Sins Communion in the Church Moral Teachings Saints Marriage & Divorce History of the Church Sin and Grace Catholic Prayer Sacraments Are there other questions or concerns you would like to have addressed in these sessions? * Marital Information Marriage Status * I have never been married I am married I am divorced, not remarried I am presently separated I am a widow, widower I have been married more than once I am divorced and remarried I have received a Catholic annulment (if married to a catholic) My spouse has been previously married I am engaged to be married How many times have you been married? * Fiancé's Name * Religion * Proposed Wedding Date * Has Fiancé Been Married Before? * Yes No Has Fiancé obtained a catholic annulment? * Yes No By whom were you married? * Where were you married? * Date of marriage * If married to a Catholic, were you married by a priest / deacon? * Your Purpose for Participating in RCIA Why are you inquiring into the catholic church? * I definitely want to become Catholic I think I want to become Catholic I'm just looking, not sure at this time I do not want to become Catholic at this time - I'm just curious Submit
