Today's Date (mm/dd/yy)
Name
Address
City
Zip
Subdivision
Home Phone

Married
Single
Divorced
Widowed

Husband's Employment
Firm
Position
Office Phone

Wife's Employment
Firm
Position
Office Phone

City and State of Origin
Husband's
Wife's

Where did family last reside
before moving to Tulsa?
Last residence

When did family move to Tulsa?
Date of moving (month/year)

When did family move to present neighborhood?
Date of moving (month/year)

For each person in your household, list below the full
full name, (nickname in parenthesis), date of birth (dd/mm/yy),
relation to you, and Catholic sacraments received.

In the Sacramental Status section, you may abbreviate as follows:

Baptism B
First Communion E
First Confession P
Confirmation C
Catholic Marriage M
Non-Catholic NC


Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Full Name
Date Of Birth
Relation
Sacramental Status

Is your present marriage recognized by the Catholic Church?
Yes
No

Wedding Date

If not, have you attempted to have the matter
reconciled with the Church?
Yes
No

With what success?

Have your family members received all the sacraments appropriate
to their ages and school grade level?
Yes
No

If not, please explain

Do any of your children require special religious training by reason
of learning isabilities, etc?
Yes
No

If so, please explain

Please list some of your experiences and abilities which you think
might be helful to this parish community:
Explain

Would a visit with the pastor be helpful to you at this time?
Yes
No

Please enter any additional comments here.