DJM Family Census
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Personal Information
First Name *
Middle Name (optional)
Last Name *
Birthday *
MM
/
DD
/
YYYY
Gender  *
Occupation
Vocation *
(Married, single, priest, deacon, sister, brother, etc.)
Current Address
Country *
Address 1 *
Address 2
City *
State *
Zip Code *
Email *
Phone Number *
(Please indicate if cell, work or home.)
(Example: (314) 222-3333 work)
Initial Formation Information
Was your initial formation conducted in a virtual or in-person group setting, or one-on-one (satellite)? *
Location of formation (in-person or one-on-one) *
(Indicate city, state, country where formation was done.)
Who was your servant leader(s)? *
 Parish you belonged to during formation period. *
Name of Pastor at the time of formation. *
Discipleship Wrap-up Retreat Information
(This is the Discipleship Wrap-up Retreat you attended at the end of your formation period.)
Retreat type (select one) *
(If you attended more than one through the years, check the first one you attended.)  
Year Completed *
(If you don't remember, try checking with your Core Group or another disciple that attended the same retreat.)
Location  *
(City, state, country where Discipleship Wrap-up Retreat was completed.)
Other - Explanation
(If your Discipleship Wrap-up Retreat was different than the options above, please explain.)
Current Parish Information
Name of Parish *
Location  *
(City, state, country where parish is located.)
Name of Pastor *
Name of Diocese or Archdiocese *
Name of Bishop or Archbishop *
Ministries you serve in *
Please indicate any ministries your Pastor and/or Bishop have asked you to serve in. *
DJM Core Group Information
How you ever served on a DJM Core Group? *
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