Inquirer Information Form - Adult "*" indicates required fields Adult Inquirer Information FormInformation is held in confidence and is not shared without your permission.Adult's Name* First Middle Last Maiden Name (If Applicable)Date of Birth* Month Day Year Age*Place of Birth* Name of Father* Name of Mother* I. Contact InformationFull Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone:DaytimePhoneEvening/WeekendPhoneCell/MobileE-Mail* E-Mail OtherName: Relationship: Religious Affiliation: II. RELIGIOUS HISTORYWhat, if any, is your present religious affiliation? 1. Has you ever been baptized? Yes No I am not sure 2. If you were baptized as a Catholic, check those sacraments you have already received Penance (Confession) Eucharist (First Communion) Confirmation If you answered “Yes” to Question 1, please provide the following information:(a) In what denomination were you baptized? (b) Date or your approximate age when you were baptized: (c) Baptismal name (if different from current name): (d) Place of Baptism (name of church/denomination): (e) Address, if known: (f) Location, if known: (include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)III. CURRENT MARITAL STATUSCheck the appropriate statement(s) below and provide any information requested beneath each statement.1. I have never been married. 2. I am engaged to be married. 2.(a) Your Fiancé(e)’s Name: 2.(b) Your Fiancé(e)’s Current Religious Affiliation (if any): 2.(c) For you This is my first marriage. I have been married before. 3.(d) For your fiancé(e): This is his/her first marriage. My fiancé(e) has been married before. 3. I am married. 3.(a) Your Spouse’s Name: 3.(b) Your Spouse’s Current Religious Affiliation (if any): 3.(c) For you This is my first marriage. I have been married before. 3.(d) For your spouse: This is my spouse’s first marriage. My spouse has been married before. 3.(e) Date of Marriage: MM slash DD slash YYYY 3.(f) Place of Marriage (include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)3.(g) Officiating Authority of Marriage: (civil government, non-Christian minister, Christian minister, Catholic cleric)4. I am married, but separated from my spouse. 5. I am divorced and I have not remarried. 6. I am a widow/widower and have not remarried since my spouse’s death. IV. FAMILY INFORMATIONList the name(s) of any children or other dependents (e.g., Daughter — Jane; Stepson — John).Relationship Age Name Relationship Age Name Relationship Age Name Relationship Age Name Relationship Age Name VI. GENERAL QUESTIONS1. What or who has led you to want to know more about the Catholic Faith?2. Please describe the types of religious education you have received, as a child and as an adult.3. What contact have you had with the Catholic Church to date?4. What are some of the questions or concerns you have about the Catholic Church?5. At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church? (please circle one) A. I need much more information about the Catholic Church before I would consider joining. B. I am considering joining, but I am still unsure about it. C. I am fairly sure that I would like to join, but I still need some time to study and pray about it. D. I am fairly sure that I want to join the Catholic Church.
