• Please complete this form if you are interested in RCIA.

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  • Today's Date REQUIRED Please fill out this field. Please enter a date.
  • Personal Information
    • Name REQUIRED Please fill out this field. Please enter valid data.
    • Mailing Address REQUIRED Please fill out this field. Please enter valid data.
    • City REQUIRED Please fill out this field. Please enter valid data.

      State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

      Zip REQUIRED Please fill out this field. Please enter a zip code.
    • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
    • Email Please enter an email address.
    • Birthdate REQUIRED Please fill out this field. Please enter a date.
    • Birthplace REQUIRED Please fill out this field. Please enter valid data.
    • Place of Employment Please enter valid data.
    • Work Phone (okay to call?) Please enter valid data.
  • Parent's Information
    • Father's Name REQUIRED

      Enter entire name, First Middle Last

      Please fill out this field. Please enter valid data.
    • Father's Religion REQUIRED Please fill out this field. Please enter valid data.
    • Mother's Name REQUIRED

      Enter entire name, First Middle (Maiden) Last

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    • Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  • Information
    • Gender REQUIRED Male Female Please fill out this field.
    • Do you presently have any relatives that are parishioners of the Gove County Catholic Parishes? REQUIRED Yes No Please fill out this field.
    • Will you need childcare while attending RCIA classes? REQUIRED Yes No Please fill out this field.
    • Have you ever attended CCD classes? REQUIRED Yes No Not sure Please fill out this field.
    • If you have attended CCD classes, at approximately what age(s)? Please enter valid data.
    • Have you been baptized? REQUIRED Yes No Not sure Please fill out this field.
    • If you have been baptized, what was the date of baptism? Please enter valid data.
    • Name of church in which you were baptized. Please enter valid data.
    • City and State where you were baptized. Please enter valid data.
    • Marital Status Married Single Widowed Never Married Engaged Divorced with annulment Divorced with no annulment Separated
    • Name of spouse or fiance. Please enter valid data.
    • Is this your spouse's/fiance's first and only marriage? Yes No
    • Who officiated your marriage? Catholic Priest Protestant Minister Justice of the Peace
    • How many times have you been married? Please enter valid data.
  • Sponsor Information
    • A sponsor is someone that is a practicing Catholic other than your spouse.
    • Do you need the parish priest to suggest a sponsor? Yes No
    • Name of Sponsor (must be 16 years of age and received the Sacrament of Confirmation) Please enter valid data.
    • Has Sponsor been baptized in the Catholic faith? Yes No
    • Has Sponsor received the Sacrament of Confirmation? Yes No
    • Sponsor's Parish Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
  • Please answer the following questions.
    • What or who led you to take an interest in the Catholic faith? REQUIRED Please fill out this field.
    • How much religious experience have you had in your life? Include belief in God, attendance at church, bible study, family religous practices, etc. REQUIRED Please fill out this field.
    • What would you hope to learn for your life from this faith journey? REQUIRED Please fill out this field.
    • Please include any other information you would like to share about yourself or that you think would be helpful for the parish priest to know? REQUIRED Please fill out this field.
  • Enter your email if you wish to be notified of the submission of the form. Please enter an email address.

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