Inquirer's Interview/Information Form - California

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INQUIRER’S INTERVIEW/INFORMATION FORM
(revised 08/10)
PERSONAL INFORMATION
Last Name:
First:
MI
□ Mr.
Marital status (circle one)
□ Miss
□ Mrs.
Single / Mar / Div / Sep / Wid
□ Ms.
Date of Birth:
/
/
Street address/apt:
Home phone:
Cell phone:
(
)
(
)
City:
State/zip code:
Email address:
RELIGIOUS BACKGROUND
Baptized: □ Yes* □ No
Religion:
Date of Baptism:
*please provide a baptismal certificate
Church of Baptism:
Address ( city/state)
MARRIAGE INFORMATION
If Married, is this your first marriage? □ Yes □ No*
Is this your spouse’s first marriage? □ Yes □ No*
Name of Spouse: (include maiden name)
Spouse’s religion:
Church of Marriage:
Date:
Address of Church:
City/State
Married by:
□ priest □ minister □ rabbi □ imam □ justice of the peace □ other
If not married in a church, list location and address where marriage took place:
IF ENGAGED, is this your first marriage? □ Yes □ No*
Is this your fiancé/fiancée’s first marriage? □ Yes □ No*
Fiancé/fiancée’s Name:
When do you plan to be married?
Where?
/
/
*IF this is NOT your First Marriage or your spouse’s/fiancé’s (fiancée’s) first marriage:
Spouse’s Name from first marriage:
Religion:
Date of this marriage:
Married by:
□ priest □ minister □ rabbi □ imam □ justice of the peace □ other
*Church or location/address of marriage:
How did this marriage end: □ divorce □ death □ annulment
Date:
INQUIRER’S INTERVIEW/INFORMATION FORM
(revised 08/10)
PERSONAL INFORMATION
Last Name:
First:
MI
□ Mr.
Marital status (circle one)
□ Miss
□ Mrs.
Single / Mar / Div / Sep / Wid
□ Ms.
Date of Birth:
/
/
Street address/apt:
Home phone:
Cell phone:
(
)
(
)
City:
State/zip code:
Email address:
RELIGIOUS BACKGROUND
Baptized: □ Yes* □ No
Religion:
Date of Baptism:
*please provide a baptismal certificate
Church of Baptism:
Address ( city/state)
MARRIAGE INFORMATION
If Married, is this your first marriage? □ Yes □ No*
Is this your spouse’s first marriage? □ Yes □ No*
Name of Spouse: (include maiden name)
Spouse’s religion:
Church of Marriage:
Date:
Address of Church:
City/State
Married by:
□ priest □ minister □ rabbi □ imam □ justice of the peace □ other
If not married in a church, list location and address where marriage took place:
IF ENGAGED, is this your first marriage? □ Yes □ No*
Is this your fiancé/fiancée’s first marriage? □ Yes □ No*
Fiancé/fiancée’s Name:
When do you plan to be married?
Where?
/
/
*IF this is NOT your First Marriage or your spouse’s/fiancé’s (fiancée’s) first marriage:
Spouse’s Name from first marriage:
Religion:
Date of this marriage:
Married by:
□ priest □ minister □ rabbi □ imam □ justice of the peace □ other
*Church or location/address of marriage:
How did this marriage end: □ divorce □ death □ annulment
Date:
FAITH FORMATION BACKGROUND
Describe your faith formation as a child:
As an adult:
What is your present religious affiliation?
Who or what has led you to the Catholic Church?
Why do you want to become a Catholic?
FOR PASTORAL STAFF
Seeking Baptism
Seeking reception into Full
Catholics seeking Full Initiation
Communion
□ Marriage certificate
□ Catechized
□ First Communion
□ Catechized
□ Baptismal certificate
□ Needs annulment
□ Uncatechized
□ First Penance
□ Uncatechized
□ Marriage certificate
□ Received annulment
□ Baptismal certificate
□ Marriage certificate
□ Needs annulment
□ Received annulment
□ Needs annulment
□ Received annulment
Notations:
Notations:
Notations:
□ Name of parish sponsor:
□ Name of sponsor/godparent:
□ Certificate/Letter of Eligibility for sponsor/godparent (issued within 6 months)
□ Confirmation Name:
Interviewed conducted by:
Date:
/
/
Signature of pastor:
Date:
/
/

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