Diocese of Worcester Massachusetts

Diocese of Worcester Massachusetts

Cursillo Application

Applicant (please print)

Name:______Address:______City:______State:______Zip:______

Telephone: ______Email Address: ______Date of Birth: ______Marital Status: ______

# of children: _____ Convert? Y/N _____ Parish: ______Parish City: ______

Occupation: ______Employed at: ______Clubs/Hobbies: ______

Disabilities or diet restrictions:

______

Signature Date

Your application will be placed on file, and you will be notified approximately six weeks before the next scheduled Cursillo weekend. If you are unable to make the scheduled dates your application will remain on file, and you will be notified of future weekend dates.

Sponsor (please print)

Name: ______Address: ______City: ______State: ______Zip: ______

Telephone: ______Email Address: ______

______

Sponsor’s Signature Date

Candidate’s Pastor: Do you agree that this candidate would benefit from a Cursillo experience? Yes or No

Comments:

______

Pastor’s Signature Date

The cost of the three-day Cursillo weekend is $150. We request that your candidate include a $25 deposit when they submit this form.

Checks should be made payable to The Cursillo Movement.

Credit Card payment: (circle one) Visa/MC/Discover Card # ______- ______- ______- ______exp date: ____ - ____ Security # on back of card. ______

Name on Card: ______billing address: ______City: ______State:_____ Zip:______

The inability to pay should not deter anyone from applying to Cursillo.