Address: __________________________________________________________________
City: ______________________________ State: ___________ ZIP: ___________________
Phone: ______________________ E-Mail Address (optional) _________________________
Single ( ) Married ( ) Widower ( ) Divorced ( ) Separated ( ) Priest ( ) Religious ( )
Spouses name (if married) ____________________
If widowed, separated, or divorced, how long? ____ Number of Children _____
Education: Circle highest level completed:
Grades: 8 9 10 11 12 
College: 1 2 3 4 Graduate degree: __________
Occupation: _____________________________Employer: _______________________________
Parish: ________________________________How long have you been a Catholic? ______
In what organizations are you currently active? _________________________________________
____________________________________________________________________________
I wish to attend the Cursillo on (date) _________________________________________
Please briefly explain why you wish to attend a Cursillo:
____________________________________________________________________________
Please be sure to answer all questions fully. Further information will be sent to you inapproximately 3 weeks in advance of the Cursillo.
Emergency Contact Name: _____________________Relationship: ____________ Phone:_________
Signature of Applicant ______________________________________ Date: _______
TO BE FILLED OUT BY THE CANDIDATE'S PASTOR:: This application needs to besent to the candidate's pastor for his comments (if any) and his signature:
If the candidate is married, is his/her marriage in good standing and recognized by theChurch?_________
Pastor's comments:
Pastor's Signature:______________________________________Date: ___________