INFORMATION FORM
Information on this form will be held in confidence by the
RCIA Team Members and will not be shared without your permission.
Today’s Date: ______
Full Name: Last First Middle
Maiden Name (if applicable) Any other name/s you have been known by
Full Mailing Address (number, street, city, state, ZIP)
Email Address Occupation
Cell Phone (including area code) Day phone Evening phone
Birthdate Place of birth—include locality (town, city, county, etc.),
region (state, province, territory, etc.) and country
o I am single o I am engaged
o I am in a committed relationship o I am living with a partner
o I am married o I have never been married
Spouse’s (or Fiancé’s) Full Name
Spouse’s (or Fiancé’s) Religious Affiliation (if any)
Date of Marriage If married in a church, what denomination?)
Place of Marriage—include locality (town, city, county, etc.,), region (state, province, territory, etc.)
Officiating Authority of Marriage (civil official, minister including denomination, Catholic cleric, rabbi)
o This is my spouse’s (or fiancé’s) first marriage
o My spouse (or fiancé) has been married _____ times previously)
o I am married, but separated from my spouse
o I have been married a total of _____ times
o I am divorced, and I have never remarried
o I have filed for an Annulment in the Catholic Church
o I am a widow/widower and have not remarried since my spouse’s death
What, if any, is your current religious affiliation? ______
Have you ever been baptized? o Yes o No o I am not sure
If you answered “Yes,” please provide the following information:
In what denomination were you baptized? ______
Location, if known: ______
Include any information you may know, including locality (town, city,
county, etc..), region (state, province, territory, etc.) and country
If baptized Catholic, please check those sacraments you have already received:
o Penance (Confession/Reconciliation) o Eucharist (First Communion)
o Confirmation
Staff
____Convalidation Date Sacraments will be administered______Initial____
Please answer the following questions as they apply to you today. Use additional sheets of paper if needed.
What or who has led you to want to know more about the Catholic Faith?
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Please describe any religious education you have received, as a child and as an adult.
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What contact have you had with the Catholic Church to date?
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Please tell us, what are some of the questions or concerns you have about the teachings of the Catholic Church? Your answer will be kept confidential but will help in the preparation of future classes.
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Today, which of the following statements best describes your present thoughts about the possibility of joining the Catholic Church?
o I need much more information about the Catholic Church before I would consider joining.
o I am considering joining, but I am still unsure about it.
o I am fairly sure that I would like to join, but I still need some time to study and pray about it.
o I am fairly sure that I want to join the Catholic Church.