SMA Parish: OCIA Adult Inquirer Form

Contact Information and Religious History

Information on this form is held in confidence and is not shared without your permission. We will respond to your application within 7 days. Thank you for your interest!

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* 1. Please provide the following information:

Today's Date

First Name

Middle Name

Last Name

Maiden Name (if applicable)

Date of Birth

Age

Place of Birth (include LOCALITY [town, city, county, etc.], REGION [state, territory, etc.], COUNTRY.

Mother's Name

Father's Name

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* 2. Please provide your contact information below:

Occupation

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

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* 3. Best time to call via phone

Daytime

Evening

Weekend

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* 4. What, if any, is your religious affiliation?

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* 5. Have you ever been baptized?

Yes

Not sure

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* 6. If your received Baptism, include the name of the church, city and state and year received:

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* 7. In what denomination did you receive baptism?

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* 8. What was your approximate age when baptized?

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* 9. What was your baptismal name (if different from current name)?

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* 10. Place of Baptism

Name of church/denomination

Address, if known

Location, if known (LOCALITY, REGION, COUNTRY)

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* 11. If you were baptized as a Catholic, check those sacraments you have already received:

Penance (Confession)

Eucharist (First Communion)

Confirmation

25% of survey complete.