OCIA Registration

Background Information

Date REQUIRED Please fill out this field. Please enter a date.

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

Middle Name (optional) Please enter valid data.

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

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

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Mobile Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Alternate Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of Birth (City/State or Region/Country) REQUIRED Please fill out this field. Please enter valid data.

Religious History

What, if any, is your present religious affiliation? REQUIRED Please fill out this field. Please enter valid data.

Have you ever been baptized? REQUIRED Yes No Not sure Please fill out this field.

If you answered Yes to the last question, please answer the following questions:

What denomination were you baptized in? Please enter valid data.

What date or approximate date were you baptized? Please enter valid data.

Place of Baptism (Name of Church and Denomination) Please enter valid data.

Street Address (if known) Please enter valid data.

City, State and Zip Code or Region/Country if outside USA) Please enter valid data.

If you were baptized in the Catholic Church, please check off the Sacraments you have received: Reconciliation or Confession First Holy Communion Confirmation

Marital Status

Are you currently single (not married)? REQUIRED Yes No Not sure Please fill out this field.

Are you currently engaged to be married? REQUIRED Yes No Please fill out this field.

If you answered YES to the last question, please answer the following:

Your Fiancé(e)’s Name: Please enter valid data.

Your Fiancé(e)’s Current Religious Affiliation (if any): Please enter valid data.

Please answer the following for yourself: This will be my first marriage I have been married before

Please answer the following for your Fiancé(e): This will be his/her first marriage He/She has been married before

Are you currently married? REQUIRED Yes No Not sure Please fill out this field.

If you answered YES to the last question, please answer the following:

Your Spouse’s Name: Please enter valid data.

Your Spouse’s Current Religious Affiliation (if any): Please enter valid data.

Please answer the following for yourself: This is my first marriage I have been married before

Please answer the following for your spourse: This is his/her first marriage He/She has been married before

Date of Marriage Please enter a date.

Place of Marriage (Name of Church, City/State or Country/Region) Please enter valid data.

Are you currently married but separated from your spouse? REQUIRED Yes No Not sure Please fill out this field.

Are you currently divorced and not remarried? REQUIRED Yes No Not sure Please fill out this field.

Are you currently a widow/er? REQUIRED Yes No Not sure Please fill out this field.