September 30, 2023 Certificate of Completion Application Please complete and submit this form to apply for the Certificate of Completion in your parish ministry from the Office of Faith Formation. Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Secondary Phone*Email* Enter Email Confirm Email Your home parish/parish town*Please choose your Parish and TownAssumption of the Blessed Virgin Mary, CentereachBlessed Sacrament, Valley StreamChrist the King, CommackCorpus Christi, MineolaCure of Ars, MerrickGood Shepherd, HolbrookHoly Cross, NesconsetHoly Family, HicksvilleHoly Name of Jesus, WoodburyHoly Name of Mary, Valley StreamHoly Spirit, New Hyde ParkImmaculate Conception, Westhampton BeachInfant Jesus, Port JeffersonMaria Regina, SeafordMary Immaculate, BellportMost Holy Trinity, East HamptonNotre Dame, New Hyde ParkOur Holy Redeemer, FreeportOur Lady of Fatima, ManorhavenOur Lady of Good Counsel, InwoodOur Lady of Grace, West BabylonOur Lady of Hope, Carle PlaceOur Lady of Loretto, HempsteadOur Lady of Lourdes, MalverneOur Lady of Lourdes, Massapequa ParkOur Lady of Lourdes, West IslipOur Lady of Mercy, HicksvilleOur Lady of Mount Carmel , PatchogueOur Lady of Ostrabrama, CutchogueOur Lady of Peace, LynbrookOur Lady of Perpetual Help, LindenhurstOur Lady of Poland, SouthamptonOur Lady of the Assumption, CopiagueOur Lady of the Isle, Shelter Island HeightsOur Lady of the Miraculous Medal, Point LookoutOur Lady of the Miraculous Medal, WyandanchOur Lady of the Snow, Blue PointOur Lady of Victory, Floral ParkOur Lady Queen of Martyrs, CenterportQueen of the Most Holy Rosary, BridgehamptonQueen of the Most Holy Rosary, RooseveltResurrection, FarmingvilleSacred Heart, CutchogueSacred Heart, Island ParkSacred Heart, North MerrickSacred Hearts of Jesus and Mary, SouthamptonSS Philip and James, Saint JamesSs. Cyril and Methodius, Deer ParkSS. Peter and Paul, ManorvilleSt. Agnes Cathedral, Rockville CentreSt. Agnes, GreenportSt. Aidan, Williston ParkSt. Aloysius, Great NeckSt. Andrew, Sag HarborSt. Anne , Garden CitySt. Anne, BrentwoodSt. Anthony of Padua, East NortportSt. Anthony of Padua, Rocky PointSt. Anthony, OceansideSt. Barnabas the Apostle, BellmoreSt. Bernard, LevittownSt. Boniface Martyr, Sea CliffSt. Boniface, ElmontSt. Brigid, WestburySt. Catherine of Sienna, Franklin SquareSt. Christopher, BaldwinSt. Dominic, Oyster BaySt. Edward the Confessor, SyossetSt. Elizabeth Ann Seton, Lake RonkonkomaSt. Elizabeth of Hungary , MelvilleSt. Frances Cabrini, CoramSt. Frances de Chantal, WantaghSt. Frances de Sales, PatchogueSt. Francis of Assisi, GreenlawnSt. Gerard Majella, Port Jefferson StationSt. Gertrude, BayvilleSt. Hedwig, Floral ParkSt. Hugh of Lincoln, Huntington StationSt. Hyacinth, Glen HeadSt. Ignatius Loyola , HicksvilleSt. Ignatius Martyr, Long BeachSt. Isadore, RiverheadSt. James, SeafordSt. James, SetauketSt. Joachim, CedarhurstSt. John Nepomucene, BohemiaSt. John of God , Central IslipSt. John the Baptist, Wading RiverSt. John the Evangelist, Center MorichesSt. John the Evangelist, RiverheadSt. Joseph the Worker, East PatchogueSt. Joseph, BabylonSt. Joseph, Garden CitySt. Joseph, HewlettSt. Joseph, Kings ParkSt. Joseph, RonkonkomaSt. Jude, Mastic BeachSt. Kilian, FarmingdaleSt. Ladislaus, HempsteadSt. Lawrence the Martyr, SayvilleSt. Louis de Montfort, Sound BeachSt. Luke , BrentwoodSt. Margaret of Scotland, SeldenSt. Mark, ShorehamSt. Martha, UniondaleSt. Martin of Tours, AmityvilleSt. Martin of Tours, BethpageSt. Mary of the Isle, Long BeachSt. Mary, East IslipSt. Mary, ManhassetSt. Mary, RoslynSt. Matthew, Dix HillsSt. Patrick, Bay ShoreSt. Patrick, Glen CoveSt. Patrick, HuntingtonSt. Patrick, SmithtownSt. Patrick, SoutholdSt. Paul the Apostle, BrookvilleSt. Peter of Alcantara, Port WashingtonSt. Peter the Apostle, Islip TerraceSt. Philip Neri, NorthportSt. Pius X, PlainviewSt. Raphael, East MeadowSt. Raymond, East RockawaySt. Rocco, Glen CoveSt. Rosalie, Hampton BaysSt. Rose of Lima, MassapequaSt. Sylvester, MedfordSt. Therese of Lisieux, MontaukSt. Thomas More, HauppaugeSt. Thomas the Apostle, West HempsteadSt. Vincent de Paul, ElmontSt. William the Abbot, SeafordOutside of Diocese of Rockville CentreSpanish ApostolateFor which parish ministry do you wish to receive a Certificate of Completion?* Parish Ministry Experience (Minimum of Three [3] Years)Parish / parish town*Please choose a Parish and TownAssumption of the Blessed Virgin Mary, CentereachBlessed Sacrament, Valley StreamChrist the King, CommackCorpus Christi, MineolaCure of Ars, MerrickGood Shepherd, HolbrookHoly Cross, NesconsetHoly Family, HicksvilleHoly Name of Jesus, WoodburyHoly Name of Mary, Valley StreamHoly Spirit, New Hyde ParkImmaculate Conception, Westhampton BeachInfant Jesus, Port JeffersonMaria Regina, SeafordMary Immaculate, BellportMost Holy Trinity, East HamptonNotre Dame, New Hyde ParkOur Holy Redeemer, FreeportOur Lady of Fatima, ManorhavenOur Lady of Good Counsel, InwoodOur Lady of Grace, West BabylonOur Lady of Hope, Carle PlaceOur Lady of Loretto, HempsteadOur Lady of Lourdes, MalverneOur Lady of Lourdes, Massapequa ParkOur Lady of Lourdes, West IslipOur Lady of Mercy, HicksvilleOur Lady of Mount Carmel , PatchogueOur Lady of Ostrabrama, CutchogueOur Lady of Peace, LynbrookOur Lady of Perpetual Help, LindenhurstOur Lady of Poland, SouthamptonOur Lady of the Assumption, CopiagueOur Lady of the Isle, Shelter Island HeightsOur Lady of the Miraculous Medal, Point LookoutOur Lady of the Miraculous Medal, WyandanchOur Lady of the Snow, Blue PointOur Lady of Victory, Floral ParkOur Lady Queen of Martyrs, CenterportQueen of the Most Holy Rosary, BridgehamptonQueen of the Most Holy Rosary, RooseveltResurrection, FarmingvilleSacred Heart, CutchogueSacred Heart, Island ParkSacred Heart, North MerrickSacred Hearts of Jesus and Mary, SouthamptonSS Philip and James, Saint JamesSs. Cyril and Methodius, Deer ParkSS. Peter and Paul, ManorvilleSt. Agnes Cathedral, Rockville CentreSt. Agnes, GreenportSt. Aidan, Williston ParkSt. Aloysius, Great NeckSt. Andrew, Sag HarborSt. Anne , Garden CitySt. Anne, BrentwoodSt. Anthony of Padua, East NortportSt. Anthony of Padua, Rocky PointSt. Anthony, OceansideSt. Barnabas the Apostle, BellmoreSt. Bernard, LevittownSt. Boniface Martyr, Sea CliffSt. Boniface, ElmontSt. Brigid, WestburySt. Catherine of Sienna, Franklin SquareSt. Christopher, BaldwinSt. Dominic, Oyster BaySt. Edward the Confessor, SyossetSt. Elizabeth Ann Seton, Lake RonkonkomaSt. Elizabeth of Hungary , MelvilleSt. Frances Cabrini, CoramSt. Frances de Chantal, WantaghSt. Frances de Sales, PatchogueSt. Francis of Assisi, GreenlawnSt. Gerard Majella, Port Jefferson StationSt. Gertrude, BayvilleSt. Hedwig, Floral ParkSt. Hugh of Lincoln, Huntington StationSt. Hyacinth, Glen HeadSt. Ignatius Loyola , HicksvilleSt. Ignatius Martyr, Long BeachSt. Isadore, RiverheadSt. James, SeafordSt. James, SetauketSt. Joachim, CedarhurstSt. John Nepomucene, BohemiaSt. John of God , Central IslipSt. John the Baptist, Wading RiverSt. John the Evangelist, Center MorichesSt. John the Evangelist, RiverheadSt. Joseph the Worker, East PatchogueSt. Joseph, BabylonSt. Joseph, Garden CitySt. Joseph, HewlettSt. Joseph, Kings ParkSt. Joseph, RonkonkomaSt. Jude, Mastic BeachSt. Kilian, FarmingdaleSt. Ladislaus, HempsteadSt. Lawrence the Martyr, SayvilleSt. Louis de Montfort, Sound BeachSt. Luke , BrentwoodSt. Margaret of Scotland, SeldenSt. Mark, ShorehamSt. Martha, UniondaleSt. Martin of Tours, AmityvilleSt. Martin of Tours, BethpageSt. Mary of the Isle, Long BeachSt. Mary, East IslipSt. Mary, ManhassetSt. Mary, RoslynSt. Matthew, Dix HillsSt. Patrick, Bay ShoreSt. Patrick, Glen CoveSt. Patrick, HuntingtonSt. Patrick, SmithtownSt. Patrick, SoutholdSt. Paul the Apostle, BrookvilleSt. Peter of Alcantara, Port WashingtonSt. Peter the Apostle, Islip TerraceSt. Philip Neri, NorthportSt. Pius X, PlainviewSt. Raphael, East MeadowSt. Raymond, East RockawaySt. Rocco, Glen CoveSt. Rosalie, Hampton BaysSt. Rose of Lima, MassapequaSt. Sylvester, MedfordSt. Therese of Lisieux, MontaukSt. Thomas More, HauppaugeSt. Thomas the Apostle, West HempsteadSt. Vincent de Paul, ElmontSt. William the Abbot, SeafordOutside of Diocese of Rockville CentreSpanish ApostolateIf outside of Diocese of Rockville Centre please list the parish name If outside of Diocese of Rockville Centre please list the parish town Name of Ministry* Please give a brief description of your role/activity in this ministry.*Please indicate when you began to serve in this ministry.*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Completion of Basic Religious Studies or School of Missionary DisciplesPlease check the box that applies:* I have received a Basic Religious Studies Certificate. I have graduated from PFI or School of Missionary Disciples When did you receive the Basic Religious Studies Certificate?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920When did you graduate from PFI or School of Missionary Disciples?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Completion of Level I and Level II Workshops for your Parish Ministry.Name of Level I Parish Ministry workshop completed:* When did you complete the Level I workshop?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Level II Parish Ministry workshop completed:* When did you complete the Level II workshop?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please check the box below before submitting your application:* I confirm that I have completed all three (3) necessary requirements to receive a Certificate of Completion in my Parish Ministry.