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

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

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY 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.
  • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Sacramental History
  • Baptism
    • Month and Year REQUIRED Please fill out this field. Please enter valid data.
    • Church and City REQUIRED Please fill out this field. Please enter valid data.
  • Confirmation
    • Month and Year REQUIRED Please fill out this field. Please enter valid data.
    • Church and City REQUIRED Please fill out this field. Please enter valid data.
  • Eucharist
    • Month and Year REQUIRED Please fill out this field. Please enter valid data.
    • Church and City REQUIRED Please fill out this field. Please enter valid data.
  • Marriage
    • If yes, please fill in month/year, church and city Please enter valid data.
    • Annulment(s)? Please fill in month/year, church and city Please enter valid data.
  • Were you ever commissioned as an EMHC in another (arch) diocese?
  • (Arch) Diocese Please enter valid data.
  • Date(s) Please enter valid data.
  • Other Comments:

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