June 24, 2020 Basic Religious Studies Certificate Application (submit no later than April 1 of the year of eligibility) Date* MM slash DD slash YYYY Title* Br. Miss Mr. Mrs. Ms. Sr. 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 E-Mail* Enter Email Confirm Email Phone Number*Please include the area code.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 ApostolatePastor* DRE* If Catholic School Teacher Complete The Following:School School 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 Principal Principal Email Phone RequirementsOld Testament*Parish/Center/College:Month/Year: New Testament*Parish/Center/College:Month/Year: Ecclesiology (Church)*Parish/Center/College:Month/Year: Christology*Parish/Center/College:Month/Year: Liturgy*Parish/Center/College:Month/Year: Morality*Parish/Center/College:Month/Year: Catechetical Leader/Principal Signature**Note - All applications must be signed by a parish catechetical leader or a school principal.Payment InformationBasic Religious Studies Certificate Application FeePayment must accompany the application. Price: Basic Religious Studies Certificate Application Total $0.00 Payment Method*You will not be considered until payment is received. By Check PayPal / Credit Card Please continue to the next page to make your payment. You must use your PayPal account or enter your credit card information.Make check payable to "The Office of Faith Formation" and mail to: Office of Faith Formation, Diocese of Rockville Centre, Attention: RSVP CSA Application, P.O. Box 9023, Rockville Centre, NY 11571-9023 Please note your parish will be notified once payment is received.