Full Name (First, Middle, Last and Suffix if applicable i.e. Sr., Jr., III, etc...) REQUIRED Please fill out this field. Please enter valid data.

Maiden Name if applicable Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

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

Home Phone Number Please enter a phone number.

Place of Work Please enter valid data.

Occupation Please enter valid data.

Work Phone Number Please enter a phone number.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of Birth - City and State REQUIRED Please fill out this field. Please enter valid data.

Father's Full Name (First, Middle, Last and Suffix if applicable i.e. Sr., Jr., III, etc...) REQUIRED Please fill out this field. Please enter valid data.

Father's Religion Please enter valid data.

Mother's Full Name (First, Middle, and Last) REQUIRED Please fill out this field. Please enter valid data.

Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion Please enter valid data.

Have you been baptized? REQUIRED Yes No Please fill out this field.

If you have been baptized, we kindly ask that you please provide a letter/certificate from the baptismal church to confirm the Baptism and date of Baptism.

Church name where you were baptized. Please enter valid data.

Church location - City and State. Please enter valid data.

How old were you when you were baptized or date of Baptism? Please enter a date.

In what faith tradition were you baptized? Please enter a date.

Was the baptism Trinitarian (In the name of the Father, Son & Holy Spirit?) Yes No Unsure

If you are Catholic, have you celebrated the sacrament of Confirmation? Yes No

If you are Catholic, have you celebrated the sacrament of Reconciliation? Yes No

If you are Catholic, have you celebrated the sacrament of Eucharist? Yes No

MARRIAGE INFORMATION:

Please fill out the following information carefully and completely. It will be very helpful to us and, in turn, to you. Thank you!

Are you now married or are you engaged to be married? REQUIRED Yes No Please fill out this field.

If you are presently married:

If you are presently married, we kindly ask that you please provide a copy of your marriage certificate.

Spouse's Full Name (First, Middle, Last and Suffix if applicable i.e. Sr., Jr., III, etc...) Please enter valid data.

Spouse's Maiden Name (If Applicable) Please enter valid data.

Date of present marriage Please enter valid data.

Place (Church: Name & Denomination) Please enter valid data.

Location of Church (City and State) Please enter valid data.

Was your spouse Catholic at the time of your marriage? Yes No

Has your spouse ever been baptized? Yes No

If yes, in what faith tradition? Please enter valid data.

Is your spouse practicing the religion into which they were baptized? Yes No

Excluding your present marriage have you ever been married before? Yes No

Date of this marriage Please enter valid data.

Place (Church: Name & Denomination) Please enter valid data.

Location of Church (City and State) Please enter valid data.

How did this marriage end? Please enter valid data.

Excluding your present marriage has your spouse ever been married before? Yes No

Date of this marriage Please enter valid data.

Place (Church: Name & Denomination) Please enter valid data.

Location of Church (City and State) Please enter valid data.

How did this marriage end? Please enter valid data.

If you are not presently married but are planning marriage:

Fiancé(e)'s Full Name (First, Middle, Last and Suffix if applicable i.e. Sr., Jr., III, etc...) Please enter valid data.

Have you ever been married before? Yes No

If yes, date of the marriage Please enter valid data.

Place (Church: Name & Denomination) Please enter valid data.

Location of Church (City and State) Please enter valid data.

How did this marriage end? Please enter valid data.

Is your fiancé(e) catholic? Yes No

Has your fiancé(e) been baptized? Yes No

If yes, in what faith tradition? Please enter valid data.

Is your Fiancé(e) practicing the religion into which s/he was baptized? Yes No

Has your Fiancé(e) ever been married before? Yes No

If yes, date of this marriage: Please enter valid data.

Place (Church: Name & Denomination) Please enter valid data.

How did this marriage end? Please enter valid data.

Children:

Do you have any children? REQUIRED Yes No Please fill out this field.

Child's - Name and Age Please enter valid data.

RCIA

St. Clare of Assisi RCIA Data Form

MARRIAGE INFORMATION:

If you are presently married:

If you are not presently married but are planning marriage:

Children: