Please read the clergy information form carefully and fill in the requested information. If we have any other questions after submission, we’ll be in touch. "*" indicates required fields HiddenNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.About YouYour Name* Title Mr.Mrs.MissMs.Dr.Prof.Rev. First Middle Last Preferred name Your Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Phone*Phone TypeMobileLandlineYour Email Address* Allergies/dietary restrictions Date of Birth* MM slash DD slash YYYY Place of Birth* Date of Baptism* MM slash DD slash YYYY Place of Baptism* Date of Confirmation/Reception* MM slash DD slash YYYY Place of Confirmation/Reception* Date of Diaconate Ordination* MM slash DD slash YYYY Place of Diaconate Ordination* Date of Presbyteral Ordination MM slash DD slash YYYY Place of Presbyteral Ordination Current Diocese* Length of time active in the above stated diocese (years/months) i.e. 7 years, 2 months* Allergies/dietary restrictions* Education/WorkName of high school, date of graduation and degree earned Name of college(s), date(s) of graduation and degree(s) earned Other educational experience(s) Are you secularly employed? If yes, list role and company Emergency Contact InformationName* Title Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Phone*Family InformationSkip if not applicableMarriage date MM slash DD slash YYYY Full name of spouse Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Spouse's email Spouse's preferred phoneName(s) and birthdate(s) of child(ren) CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
