April 28, 2015 Online PFI 2015 – 2016 Application 1 2 3 1. Complete and submit this application. 2. Upload or email a photo (passport or similar type) of yourself along with this application. Personal InformationName* First Middle Last Suffix Telephone*Email* Enter Email Confirm Email Mailing Address* Street Address Town ZIP Code Parish*Parish Town*Country of Origin?*What is your primary language?*What other languages do you speak, read or write?*Emergency ContactName* First Last Telephone*Have you participated in VIRTUS (The Diocesan Training Program for the prevention, recognition and reporting of child abuse).*I haveI have notStatusMarital Status*SingleMarriedWidowedSeparatedDivorcedRemarriedReligiousIf married, name of spouse First Last EducationPlease check all that apply to you:* High School Associate Degree Bachelor’s Degree Graduate Studies Religious Education Please specify your Religious EducationDo you participate in any ministries in your parish? Which ones? Catechist Lector Outreach Extraordinary Minister of Holy Communion Ministry of Consolation Youth Group Choir Other Please specifyUpload photo Please upload a photo (passport or similar type) if you wish to email your photo please email Karol Garcia, email@example.com with the subject PFI APPLICATION PHOTO and give your name and contact information. You can also mail you photo along with contact information to Diocese of Rockville Centre, Office of Faith Formation Attention: Karol Garcia PO Box 9023, Rockville Centre, NY. 11571- 9023. Photo uploadPlease submit your photo in a jpg format Payment Per Year Fee: $ 800.00 includes 28 weekly sessions of instruction, 1 weekend retreat and 2 days of formation per year. First payment of $100.00 due September 1st, 2015. Payment options available. Some scholarships are available on yearly basis Sign Your ApplicationName* First Last Date* Check this box if you have reviewed your application and are ready to submit. Checking this box is the same as signing your application.* Yes, I have reviewed my application and understand the terms of this form. For more information, please contact: Karol Garcia, Phone 516-678-5800 ext. 540, email: firstname.lastname@example.org Fax: 516-536-3473 MAKE SURE TO REVIEW AND PRINT OUT A COPY FOR YOUR RECORDS.