Diaconate Inquiry Form

Full Baptismal name (please include middle name) REQUIRED Please fill out this field. Please enter valid data.

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

Mailing 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.

Name of Church Parish REQUIRED Please fill out this field. Please enter valid data.

Pastor's Name REQUIRED Please fill out this field. Please enter valid data.

Home Phone REQUIRED Please fill out this field. Please enter valid data.

Work Phone Please enter valid data.

Cell Phone Please enter valid data.

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

Date of birth REQUIRED Please fill out this field. Please enter valid data.

Place of birth (city and state) REQUIRED Please fill out this field. Please enter valid data.

Place of Employment REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Single Married Widowed Divorced Please fill out this field.

Education Level REQUIRED High School College Grad School (Masters Degree) Post Grad (Doctorate) Please fill out this field.

Spouse's legal name Please enter valid data.

Spouse's date of birth Please enter valid data.

Spouse's Occupation Please enter valid data.

Do you and your spouse have children? Yes No

If yes, please specify their ages.

Diocese of Lafayette Permanent Diaconate Formation