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  • DEACON:
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Email Please enter an email address.
  • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  • RETREAT INFORMATION
  • Please list all retreats that you attended during 2019. REQUIRED I attended a retreat during the calendar year. I did NOT attend a retreat during the calendar year. Please fill out this field.
  • Check: My wife attended this retreat with me.
  • WIFE:
    • First Name Please enter valid data.

      Last Name Please enter valid data.
    • Retreat Information (WIFE) None I attended a retreat this year. (2019) I have not attended a retreat in the last 3 years.
  • Other Retreat(s) or days of reflection (Please include date, location and theme):
  • Check: My wife attended with me.
  • Do you have suggestions for locations and/or retreat theme in the future?
  • CONTINUING EDUCATION INFORMATION

  • Please indicate all CE events in which you participated during the 2021 calendar year.

  • Educational Programs Offered for Permanent Deacons Annual Deacon Convocation
  • Diocesan Educational Programs:
    • Date: Please enter valid data.
    • Presenter: Please enter valid data.
    • Theme: Please enter valid data.
    • Location: Please enter valid data.
  • Other Diocesan Programs offered:
    • Please list date and theme: Please enter valid data.
  • Programs/Courses offered by other Institutions:
    • Institution Please enter valid data.
    • Date: Please enter valid data.
    • Presenter: Please enter valid data.
    • Theme: Please enter valid data.
    • Location: Please enter valid data.
  • Programs/Courses offered by other Institutions:
    • Institution and Theme: Please enter valid data.
  • Self-Directed Studies
    • Study Source Please enter valid data.
    • Author/Presenter: Please enter valid data.
    • Theme: Please enter valid data.
  • Leadership Activities (presentations/lectures, directed retreat, etc., that you led.)
    • Event and Theme: Please enter valid data.
  • Other:
    • Date: Please enter valid data.
    • Event Please enter valid data.
    • Location: Please enter valid data.
    • Theme: Please enter valid data.
    • Role: Please enter valid data.
  • Any general or additional comments you would like to express:
  • Other INFORMATION:
    • Supervising Priest REQUIRED Please fill out this field. Please enter valid data.
    • Spiritual Director: REQUIRED Please fill out this field. Please enter valid data.
    • Spiritual Direction: (Check all that apply) REQUIRED I met with my Spiritual Director at least four times during 2021. I met with my Spiritual Director at least once during 2021. I did not meet with my spiritual director. I do not have a spiritual director currently. Please fill out this field.
  • HEALTH: How are you doing both health-wise and spiritually? Please let me know, especially if you are experiencing challenges. (Note: this information is held in strictest confidence) REQUIRED Please fill out this field.

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