CURSILLO – APPLICATION

Return to: Cursillo Movement – Diocese of Erie

                                                                                                Date Received: ________________  

Name: ______________________________________________________________________________________

(Please Print or Type)          (Last)                      (First)                     (Initial)                   (Nickname)            (Maiden Name)

Street: ______________________________________________________________________________________

City: _______________________ State: _______ Zip: ___________ Phone: (_____) _______________________

Parish: ________________________________ City: ________________________________ Age: ____________

E-mail address (if any) _______________________________________ 

Marital Status:            Single *           Married *          Widowed*        Separated *        Divorced *        Male* Female*

*Please note last two lines at bottom of this sheet.  Important information needed there.

Religious Denomination of Spouse: ________________________________________________________________________

Number of Children (if any): ________ If Convert, date of Conversion: ___________________________________

Education: ________________________________ Occupation __________________________________________

Although Cursillo is primarily a religious experience, it is very physically and emotionally demanding also.

a)                   If you are on any medication which affects the brain, or undergoing intensive counseling, please check yes

or no so that our spiritual director is aware of your special needs. ________ yes ________ no

b)                   If you have any medical problems, such as diabetes, pregnancy, disability, arthritis, or special dietary

requirements, please check yes or no so that our spiritual director is aware of your special needs. ____ yes ______ no

Please specify __________________________________________________________________________________

In what way do you participate in parish, diocesan or community activities (list specifically):

______________________________________________________________________________________________

Has the Cursillo Movement been explained to your satisfaction? _____________________________________________________

Do you play a musical instrument? ___________If yes, which one? _________________________________________

Do you require a special diet?  Yes _____  No _____ Explain ___________________________________________________________

Sponsor:                Name: _________________________________________________________________________________

                                Street: _________________________________________________________________________________

                                City: _______________________________________________ State: _____________ Zip: _____________

                                Phone: (home) _________________________ (office) ____________________ (cell phone) ______________________

__________________________________________ ________________ __________________________________ _______________

(Signature of Applicant)                                        (Date)         

If you live outside Erie County, send application and letter of recommendation through your area coordinator.