DISCIPLESHIP COHORTS Intake Form Question Title * 1. Contact Information First Name Last Name Telephone Email Title/Role at Parish/Entity Question Title * 2. Parish / Entity Name and City All Souls, Sanford Annunciation, Altamonte Springs Ascension, Melbourne Basilica of St. Paul, Daytona Beach Basilica of the National Shrine of Mary, Queen of the Universe, Orlando Bishop Moore Catholic, Orlando Blessed Sacrament, Clermont Blessed Sacrament, Cocoa Blessed Trinity, Ocala Blessed Trinity, Orlando Catholic Charities of Central Florida Centro Guadalupano Mission, Wahneta Christ the King Mission, Ocala Corpus Christi, Celebration Divine Mercy, Merritt Island Epiphany, Port Orange Father Lopez Catholic High School, Daytona Beach Good Shepherd, Orlando Holy Cross, Orlando Holy Family, Orlando Holy Name of Jesus, Indialantic Holy Redeemer, Kissimmee Holy Spirit, Lake Wales Holy Spirit, Mims Immaculate Conception, Melbourne Beach Immaculate Heart of Mary, Candler Melbourne Central Catholic High School, Melbourne Misión Católica La Guadalupana, Ocala Morning Star Catholic School, Orlando Most Precious Blood, Oviedo Nativity, Longwood Our Lady of Grace, Palm Bay Our Lady of Hope, Port Orange Our Lady of Lourdes, Daytona Beach Our Lady of Lourdes, Melbourne Our Lady of the Lakes, Deltona Our Lady of the Springs, Ocala Our Lady Star of the Sea, New Smyrna Beach Our Saviour, Cocoa Beach Prince of Peace, Ormond Beach Queen of Peace, Ocala Resurrection, Lakeland Resurrection, Winter Garden Sacred Heart, New Smyrna Beach San Jose Mission, Pierson San Pedro de Jesus Maldonado Mission, Wildwood Santa Fe Catholic High School, Winter Haven Santo Toribio Romo Mission, Mascotte St. Andrew, Orlando St. Ann, Debary St. Ann, Haines City St. Anthony, Lakeland St. Augustine, Casselberry St. Brendan, Ormond Beach St. Catherine of Siena, Kissimmee St. Charles Borromeo, Orlando St. Clare, Deltona St. Elizabeth Ann Seton Mission, Fort Meade St. Faustina, Clermont St. Francis of Assisi, Apopka St. Gerard Mission, Edgewater St. Hubert of the Forest Mission, Astor St. Ignatius Kim Korean Mission, Orlando St. Isaac Jogues, Orlando St. James Cathedral, Orlando St. John Neumann, Lakeland St. John the Baptist, Dunnellon St. John the Evangelist, Viera St. John Vianney, Orlando St. Joseph of the Forest Mission, Ocala St. Joseph, Lakeland St. Joseph, Orlando St. Joseph, Palm Bay St. Joseph, Winter Haven St. Jude, Ocala St. Lawrence, Bushnell St. Luke, Barefoot Bay St. Margaret Mary, Winter Park St. Mark the Evangelist, Summerfield St. Mary Magdalen, Altamonte Springs St. Mary of the Lakes, Eustis St. Mary, Rockledge St. Matthew, Winter Haven St. Patrick, Mount Dora St. Paul, Leesburg St. Peter, Deland St. Philip Phan Van Minh, Orlando St. Rose of Lima, Poinciana St. Stephen, Winter Springs St. Teresa, Titusville St. Theresa, Belleview St. Thomas Aquinas, Bartow St. Thomas Aquinas, St. Cloud St. Timothy, The Villages St. Vincent de Paul, Wildwood Sts. Peter and Paul, Winter Park Trinity Catholic High School, Ocala Question Title * 3. Entity Type Parish Mission School Other Question Title * 4. Deanery Central Deanery North (Seminole, Orange County) Central Deanery South (Orange, Osceola County) Eastern Deanery (Volusia County) Northern Deanery (Marion, Lake, Sumter County) Southern Deanery (Brevard County) Western Deanery (Polk County) Question Title * 5. Does your pastor support your involvement in a discipleship cohort? Yes No Question Title * 6. Can you commit to weekly meetings of approximately 90-120 minutes during normal business hours? Yes No Question Title * 7. What day/time would you be available for? Please select all that apply Monday morning Monday afternoon Tuesday morning Tuesday afternoon Wednesday morning Wednesday afternoon Thursday morning Thursday afternoon Friday morning Friday afternoon Done