RCIA Required Sacramental Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Maiden Name (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

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

City/State/Zip Code REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

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

I am most easily contacted via Phone Email Other

If Other, Please list form of contact. Please enter valid data.

Gender Male Female

Father's First Name REQUIRED Please fill out this field. Please enter valid data.

Father's Middle Name REQUIRED Please fill out this field. Please enter valid data.

Father's Last Name REQUIRED Please fill out this field. Please enter valid data.

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

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

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

Mother's Maiden Name (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

Baptized - NOTE: Copy of Baptismal Certificate Required YES NO UNSURE

*For Baptized Persons*

Denomination Baptized Into (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

Place of Baptism (Full Name and Address) (or n/a if none) REQUIRED Please fill out this field.

Date of Baptism (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

If Baptized Catholic, what other Sacraments have you received? (Check all that Apply) Confirmation Holy Eucharist Penance (Confession) Marriage

*Marrital History*

#1. Are you Currently Married? YES NO

#2. If YES to #1, Were Either You or Your Spouse Previously Married to Another Person? YES NO

Please List all Prior Marriages for both You and Your Spouse (or n/a if none) REQUIRED Please fill out this field.

#3. If NO to #1, Have You Been Married Before? YES NO

Please List All Previous Marriages (or n/a if none)

#4. If Any of Your Previous Marriages have been Annulled Through the Catholic Church, Please List those Now. (or n/a if none) REQUIRED Please fill out this field.

#5. Are You Engaged to be Married? YES NO

#6. If YES to #5, What is the Faith Denomination of your Fiance? (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

#7. If YES to #5, What is the date of your impending Marriage? (or n/a if none) REQUIRED Please fill out this field. Please enter valid data.

Saint Catherine of Siena

Wichita, Kansas

RCIA Required Sacramental Information

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