RCIA APPLICATION FORM

Name ___________________________________________________    Home phone _____________

            Last                                    Middle             First                               Work phone _____________

                                                                                                                Email _____________________

Address ___________________________________________________________

City _____________________________________  State ______________  Zip  __________________

Date of Birth _____________________________   Birthplace ____________________________________

Father’s Name ______________________________________________  Religion __________________

Mother’s Name _____________________________________________  Religion __________________

Have you been baptized?    ______ Yes    ________  No

If yes, in what denomination? _________________________________ More than once? _______________

                              When __________________________________________________________________