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Head of Household
* Title
None
Mr.
Ms.
Mrs.
Miss
Dr.
M/M
D/M
M/D
D/D
Suffix
None
Sr.
Jr.
II
III
IV
V
VI
VII
VIII
XV
X
* First Name
* Last Name
Middle Name
Nickname
Relationship
Aunt
Brother
Child
Cousin
Daughter
Father
Grandchild
Grandfather
Grandmother
Head
Mother
Nephew
Niece
Other
Sister
Son
Spouse
Stepchild
Stepfather
Stepmother
Uncle
Maiden Name
Ethnicity
African American
Asian
Caucasian
Chinese
Ethiopian
Filipino
Hispanic
Italian
Jordanian
Korean
Lithuanian
Mexican
Nigerian
Polish
Vietnamese
* Birth Date
* Gender
Female Male
Grade/Degree
K
1
2
3
4
5
6
7
8
9
Subsidy
Prep 1 Monday
rcic
0
young adult
rcia
Language
English
italian
Polish
Spanish
Vietnamese
* Marital Status
Divorced
Married
Roman Catholic-Married
Single
Widowed
Phone 1
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Phone 2
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Email 1
Primary Email
Unlisted
Send Email Instead of Mail When Possible
Sacraments
Baptism
Yes
No
Date
Reconciliation
Yes
No
Date
First Communion
Yes
No
Date
Confirmation
Yes
No
Date
Marriage
Yes
No
Date
Spouse
Title
None
Mr.
Ms.
Mrs.
Miss
Dr.
M/M
D/M
M/D
D/D
Suffix
None
Sr.
Jr.
II
III
IV
V
VI
VII
VIII
XV
X
First Name
Last Name
Middle Name
Nickname
Relationship
Aunt
Brother
Child
Cousin
Daughter
Father
Grandchild
Grandfather
Grandmother
Head
Mother
Nephew
Niece
Other
Sister
Son
Spouse
Stepchild
Stepfather
Stepmother
Uncle
Maiden Name
Ethnicity
African American
Asian
Caucasian
Chinese
Ethiopian
Filipino
Hispanic
Italian
Jordanian
Korean
Lithuanian
Mexican
Nigerian
Polish
Vietnamese
Birth Date
Gender
Female Male
Grade/Degree
K
1
2
3
4
5
6
7
8
9
Subsidy
Prep 1 Monday
rcic
0
young adult
rcia
Language
English
italian
Polish
Spanish
Vietnamese
Marital Status
Divorced
Married
Roman Catholic-Married
Single
Widowed
Phone 1
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Phone 2
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Email 1
Primary Email
Unlisted
Send Email Instead of Mail When Possible
Sacraments
Baptism
Yes
No
Date
Reconciliation
Yes
No
Date
First Communion
Yes
No
Date
Confirmation
Yes
No
Date
Marriage
Yes
No
Date
Family Street Address
* Line 1
Line 2
* City
* State
Alabama (AL)
Alaska (AK)
American Samoa (AS)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Federated States of Micronesia (FM)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Marshall Islands (MH)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Northern Mariana Islands (NP)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Palau (PW)
Pennsylvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virgin Islands (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Alberta (AB)
British Columbia (BC)
Manitoba (MB)
New Brunswick (NB)
Newfoundland and Labrador (NL)
Northwest Territories (NT)
Nova Scotia (NS)
Nunavut (NU)
Prince Edward Island (PE)
Saskatchewan (SK)
Ontario (ON)
Quebec (QC)
Yukon (YT)
Other
* ZIP
Family Mailing Address
Line 1
Line 2
City
State
Alabama (AL)
Alaska (AK)
American Samoa (AS)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Federated States of Micronesia (FM)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Marshall Islands (MH)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Northern Mariana Islands (NP)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Palau (PW)
Pennsylvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virgin Islands (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Alberta (AB)
British Columbia (BC)
Manitoba (MB)
New Brunswick (NB)
Newfoundland and Labrador (NL)
Northwest Territories (NT)
Nova Scotia (NS)
Nunavut (NU)
Prince Edward Island (PE)
Saskatchewan (SK)
Ontario (ON)
Quebec (QC)
Yukon (YT)
Other
ZIP
Family Phone Numbers
* Primary
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Other
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Email
* Email
Primary Email
Unlisted
Send Email Instead of Mail When Possible
Member 1
Type
Head of Household
Spouse
Adult
Young Adult
Child
Other
Title
None
Mr.
Ms.
Mrs.
Miss
Dr.
M/M
D/M
M/D
D/D
Suffix
None
Sr.
Jr.
II
III
IV
V
VI
VII
VIII
XV
X
First Name
Last Name
Middle Name
Nickname
Relationship
Aunt
Brother
Child
Cousin
Daughter
Father
Grandchild
Grandfather
Grandmother
Head
Mother
Nephew
Niece
Other
Sister
Son
Spouse
Stepchild
Stepfather
Stepmother
Uncle
Maiden Name
Ethnicity
African American
Asian
Caucasian
Chinese
Ethiopian
Filipino
Hispanic
Italian
Jordanian
Korean
Lithuanian
Mexican
Nigerian
Polish
Vietnamese
Birth Date
Gender
Female Male
Grade/Degree
K
1
2
3
4
5
6
7
8
9
Subsidy
Prep 1 Monday
rcic
0
young adult
rcia
Language
English
italian
Polish
Spanish
Vietnamese
Marital Status
Divorced
Married
Roman Catholic-Married
Single
Widowed
Phone 1
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Phone 2
Cell Her
Cell Him
Cellular
Home
( )
-
Unlisted
Email 1
Primary Email
Unlisted
Send Email Instead of Mail When Possible
Sacraments
Baptism
Yes
No
Date
Reconciliation
Yes
No
Date
First Communion
Yes
No
Date
Confirmation
Yes
No
Date
Marriage
Yes
No
Date