Cursillo Application (Step 1 of 2)
The Catholic Cursillo is open to baptized Catholics. The candidate should be physically well, emotionally stable and able to receive the Sacraments of the Church. The Cursillo is a method of giving those who have a potential for influencing others, a personal encounter with Christ to further enhance, support and spread the Gospel of Jesus Christ. A CURSILLO SPONSOR IS REQUIRED TO ATTEND THIS RETREAT. If you don't have a sponsor, please contact: Anna Harter (women) at (580) 481-8615, or Jim Wells (men) at
Applicant Full Name
Address - street, city, state, and zip code
Which Weekend Would You Like to Attend?
Men's English - June 28- July 1, 2018
Women's English - October 25-28, 2018
Men's English - November 15-18, 2018
Men's English - March 14-17, 2019
Women's English - June 28-Jul 1, 2019
Men's English - October 3-6, 2019
Women's English October 17-20, 2019
Women's English - March 12-15, 2020
Men's English - July 16-19, 2020
Women's English - November 5-8, 2020
Men's English November 19-22, 2020
Single/Private Room $240 (medical need only)
Double/Shared Room $140
Form of Payment
Self-Pay (pay online using link provided at the end of questionnaire)
Pre-Authorized Partial Scholarship (Contact the Spiritual Life Center at 316-744-0167 for payment)
Pre-Authorized Full Scholarship (Contact Jean Cross at 316-655-8896)
Are you free to receive the Sacraments?
Any dietary restrictions, allergies, or physical restrictions we should know about?
Emergency Contact Name and Phone Number
Do you have a Cursillo Sponsor?
Cursillo Sponsor's Full Name
Cursillo Sponsor's Parish
Cursillo Sponsor's Phone and Email Address
Cursillo Sponsor's Mailing Address
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service