Office for Permanent Diaconate

Application for Husbands

Questionnaire for Wives

Step 1 of 8

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Identifying Information

Legal Name:(Required)

First Middle Last

Preferred First Name:(Required)

Email Address:(Required)

Alternate Email Address:

Your Parish:(Required)

Your Pastor:(Required)

How long have you lived in this Parish?(Required)

Wife's Legal Name:(Required)

First Middle Last

Date of Marriage:(Required)

Church of Marriage:(Required)

City, State, Country(Required)

City State / Province / Region Country

Do you have any previous marriages?(Required)

Yes

If you were married outside of the Catholic Church, indicate date and diocese of convalidation:

Diocese of convalidation:

Church law requires that: An unmarried candidate for the permanent diaconate must assume before God and the Church the obligation of celibacy. This commitment to celibacy for an unmarried candidate is made during the rite of ordination. A married deacon who becomes widowed cannot remarry. DO YOU CLEARLY UNDERSTAND AND AGREE TO THE ABOVE REQUIREMENTS?(Required)

Yes

Religious History

Are you a Roman Catholic?(Required)

Yes

Date Baptized:(Required)

If you were baptized in another Christian church, when did you make your profession of faith into the Roman Catholic Church?

Have you ever been a member of a church or religious organization other than the Roman Catholic Church?(Required)

Yes

Please briefly describe your membership in a church or religious organization other than the Roman Catholic Church?

Since becoming a Catholic, have you ever been away from active practice of the Catholic faith?(Required)

Yes

Please briefly explain the time you were away from active practice of the Catholic faith.:

Approximate dates you were away from active practice of the Catholic faith:

Ex.) Dec 2020 - March 2021

How frequently do you participate in the Celebration of the Eucharist?(Required)

Daily	Weekly	Occasionally	Seldom	Never

How frequently do you participate in the Sacrament of Reconciliation?(Required)

Yearly	Monthly	Weekly	Daily	Never

Do you have a regular confessor?(Required)

Yes

Do you have a spiritual director?(Required)

Yes

Briefly describe your personal prayer life:

Who is your closest adult friend (outside of your family)?(Required)

Describe your relationship:(Required)

Professional Background

What is your occupation?(Required)

Who is your current employer?(Required)

What is your title/position?(Required)

Clearly describe the work you currently do and its responsibilities:(Required)

Previous Employer 1: Name of Organization(Required)

Previous Employer 1: Title/Position(Required)

Previous Employer 1: Start to End(Required)

Ex. ) Jun. 2020 - Jan. 2021

Previous Employer 2: Name of Organization

Previous Employer 2: Title/Position

Previous Employer 2: Start to End

Ex. ) Jun. 2020 - Jan. 2021

Previous Employer 3: Name of Organization

Previous Employer 3: Title/Position

Previous Employer 3: Start to End

Ex. ) Jun. 2020 - Jan. 2021

Have you ever served in the Military?(Required)

Yes

Family

How many children do you have?(Required)

Child 1: Full Name

Child 1: Date of Birth

Child 1: Age

Please enter a number less than or equal to 100.

Child 1: Living at home?

Yes

Child 1: Married?

Yes

Child 2: Full Name

Child 2: Date of Birth

Child 2: Age

Please enter a number less than or equal to 100.

Child 2: Living at home?

Yes

Child 2: Married?

Yes

Child 3: Full Name

Child 3: Date of Birth

Child 3: Age

Please enter a number less than or equal to 100.

Child 3: Living at home?

Yes

Child 3: Married?

Yes

Child 4: Full Name

Child 4: Date of Birth

Child 4: Age

Please enter a number less than or equal to 100.

Child 4: Living at home?

Yes

Child 4: Married?

Yes

Child 5: Full Name

Child 5: Date of Birth

Child 5: Age

Please enter a number less than or equal to 100.

Child 5: Living at home?

Yes

Child 5: Married?

Yes

Child 6: Full Name

Child 6: Date of Birth

Child 6: Age

Please enter a number less than or equal to 100.

Child 6: Married?

Yes

Child 6: Living at home?

Yes

What have you enjoyed most about being a parent?(Required)

Please briefly describe any dependents you have other than "own children":(Required)

Please indicate any potential and pending legal actions involving you or members of your family:

Have you or any member of your family ever been arrested?(Required)

Yes

Please briefly describe circumstances, dates, and outcomes of arrest(s):

Education

Did you attend elementary school or equivalent?(Required)

Yes

Elementary school attended (1): Name of School(Required)

Elementary school attended (1): City, State, Country(Required)

City State / Province / Region Country

Elementary school attended (1): Start to finish date(Required)

Ex.) April 2020 - Dec. 2020

Elementary school attended (1): Grades Completed(Required)

Elementary school attended (2): Name of School

Elementary school attended (2): City, State, Country

City State / Province / Region Country

Elementary school attended (2): Start to finish date

Ex.) April 2020 - Dec. 2020

Elementary school attended (2): Grades Completed

Elementary school attended (3): Name of School

Elementary school attended (3): City, State, Country

City State / Province / Region Country

Elementary school attended (3): Start to finish date

Ex.) April 2020 - Dec. 2020

Elementary school attended (3): Grades Completed

Did you attend high school or equivalent?(Required)

Yes

High school attended (1): Name of School

High school attended (1): City, State, Country

City State / Province / Region Country

High school attended (1): Start to finish date

Ex.) April 2020 - Dec. 2020

High school attended (1): Grades Completed

Was a diploma granted?(Required)

Yes

Did you attend college, university, technical/training school?(Required)

Yes

College, University, Technical/Training School attended (1): Name of School

College, University, Technical/Training School attended (1): City, State, Country

City State / Province / Region Country

(1): Major/Focus of Training

College, University, Technical/Training School attended (1): Start to finish date

Ex.) April 2020 - Dec. 2020

(1): Degree/Certificate Completed

College, University, Technical/Training School attended (2): Name of School

College, University, Technical/Training School attended (2): City, State, Country

City State / Province / Region Country

(2): Major/Focus of Training

College, University, Technical/Training School attended (2): Start to finish date

Ex.) April 2020 - Dec. 2020

(2): Degree/Certificate Completed

College, University, Technical/Training School attended (3): Name of School

College, University, Technical/Training School attended (3): City, State, Country

City State / Province / Region Country

(3): Major/Focus of Training

College, University, Technical/Training School attended (3): Start to finish date

Ex.) April 2020 - Dec. 2020

(3): Degree/Certificate Completed

Have you done any post-graduate work?(Required)

Yes

Did you receive a degree?(Required)

Yes

If yes, what degree?

Have you taken any Theology courses?(Required)

Yes

What is your primary language?(Required)

Are you fluent in any other languages?(Required)

Yes

What language(s) can you read?(Required)

What language(s) can you write?(Required)

List any special skills you have:(Required)

Marital Information

Describe what you see as the real strengths in your marriage relationship:

Have you ever had any marriage or psychological counseling in the past?(Required)

Yes

Please briefly describe any past marriage or psychological counseling:

What have you done to enrich your marriage and family life?(Required)

What do you feel are the greatest blessings you have received through your marriage?(Required)

What has been the greatest cross you and your wife have borne together as a married couple?(Required)

What do you see in your marriage that strengthens and stabilizes it?(Required)

Formation will place added demands upon both you and your wife's schedule and energy. Have you discussed, together with your family, how this will impact your lives? Please briefly explain:(Required)

If you have younger children at home who require adult supervision, what arrangements will you make for their care when you are away from home evenings and weekends?(Required)

After discussing it with your spouse, please express your understanding of the above statement and your OPENNESS TO ACCEPTING ORDAINED MINISTRY AS A WAY OF LIFE in the context of your on-going commitment of marriage:(Required)

Health Information

What is the general state of your health? Describe any conditions for which you are currently being treated, or taking medication for.(Required)

Does your wife or any of your children have any special health problems?(Required)

Yes

Please briefly describe any special health problems that your wife or children may have.

Have you been hospitalized during the last ten years?(Required)

Yes

When and for what reason were you hospitalized in the last ten years?

Have you been seriously ill in the past five years?(Required)

Yes

When and what illness?

Do you currently have health insurance?(Required)

Yes

Has there been any history of spousal abuse?(Required)

Yes

Please briefly explain history of spousal abuse:

Have you ever suffered from any type of child abuse, sexual abuse or mental illness?(Required)

Yes

Please briefly explain your experience with child abuse, sexual abuse, or mental illness:

Have you ever experienced, or been accused of sexual misconduct or harassment?(Required)

Yes

Please briefly explain your experience with sexual misconduct or harassment:

Have you or your spouse ever had any problem with the use of alcohol or drugs?(Required)

Yes

Please briefly describe problems with alcohol or drug use by you or your spouse:

Have you ever been under the care of a licensed counselor (psychiatrist, psychologist, social worker)?(Required)

Yes

How long did you go to a licensed counselor (psychiatrist, psychologist, social worker)?

Start to finish in years

Reason you received counseling and outcome of counseling?

Are you aware of any compulsive behaviors in your personal life?(Required)

Yes

Please briefly describe your experience with compulsive behaviors, and what you have done or are doing to address them?

Additional Information

Have you ever applied for admission to any seminary?(Required)

Yes

Please provide the name of seminary

Please provide the location of seminary: City, State, Country

City State / Province / Region Country

Seminary Date of application

Reasons for leaving

Have you ever been a postulant, novice or professed member of any religious order, congregation, or community?(Required)

Yes

Please provide the name of order

Please provide the location of order: City, State, Country

City State / Province / Region Country

Order Date of application

Reasons for leaving

Have you ever before applied for the Permanent Diaconate in this or any other diocese?(Required)

Yes

Provide the name of the diocese

Date

Results of your application

Why do you want to be a deacon?

What personal gifts/talents would you bring to diaconal ministry?

Who most influenced your decision to apply for Diaconate Formation? How did they influence you?

What experience have you had teaching, leading, or speaking before groups of adults either at church or work, or in other settings? Please describe:

Please indicate which, if any, Christian formation experiences or contemporary Church movements you have participated in, such as: Cursillo, Charismatic Renewal Community, Marriage Encounter, Individual/Couples' Retreat, Other: Describe briefly and provide dates:

Do you currently participate in any of these groups? Briefly describe your level of involvement:

Have you ever read any of the documents from Vatican II?(Required)

Yes

Which ones have you read (all or part)?

Have you ever taken any adult religious education classes or other enrichment programs in the Church?(Required)

Yes

If so, please list, and describe how they have benefited you:

Have you been involved in parish ministries in the past five years?(Required)

Yes

Parish Ministry 1: Type of Ministry(Required)

Parish Ministry 1: Your Role(Required)

Parish Ministry 1: Start to finish date(Required)

Ex. ) July 2020 - July 2021

Parish Ministry 2: Type of Ministry

Parish Ministry 2: Your Role

Parish Ministry 2: Start to finish date

Ex. ) July 2020 - July 2021

Parish Ministry 3: Type of Ministry

Parish Ministry 3: Your Role

Parish Ministry 3: Start to finish date

Ex. ) July 2020 - July 2021

List in order of importance what you value most in life:(Required)

The Church emphasizes the deacon's role in ministries of charity and justice. Do you feel you have a special calling to serve in this area of ministry?(Required)

Yes

Please briefly describe how you might see yourself serving the poor and marginalized people of the Church and world around us:

Describe your current service activities in your parish or civic community:

Are there any particular areas of ministry in charity and justice which you would like to know more about or become more involved with in the future?(Required)

Yes

Please explain.

How do you relate to people in the Church who think or act differently than you?

How would you relate to people who have strong opinions about scripture, the Church, or faith that are contrary to your understandings?

How long have you resided in the Diocese of San Diego?

How long do you plan to remain in the Diocese of San Diego?

Formation and diaconal life will place added demands on you and your professional/occupational life. Are you open to the impact this will have on your schedule and energy?(Required)

Yes

If you should be ordained a permanent deacon and the Bishop sees a need to assign you to a parish other than your own, would you be willing to serve outside your current parish?(Required)

Yes

Are you open to making a commitment to all aspects of the formation program?(Required)

Yes

Would you like to explain anything about your answer to the previous question?

Consent(Required)

I testify that all the information on this form is true and accurate to the best of my knowledge.

Signature(Required)

Name

This field is for validation purposes and should be left unchanged.

Contacts

Rev. Eduardo A. Samaniego, SJ
Director
Phone: (858) 490-8216
esamaniego Email at symbol

sdcatholic.org

Clarissa Martinez
Associate Director
Phone: (858) 490-8298
cmartinez Email at symbol

sdcatholic.org

Mark Smith
Administrative Assistant
Phone: (858) 490-8239
msmith Email at symbol

sdcatholic.org