CURSILLO LEADERSHIP APPLICATION

Name _____________________________________ Your Cursillo _________________________________

Nickname __________________________________ Home Phone _________________________________

Address ____________________________________ Work Phone ________________________________

City/State/Zip ____________________________________________________________________________

Diocese ____________________ Home Parish ____________________ Priest Name __________________

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4^th Day Activites: Are you a confirmed Episcopalian? ____________

Are you regular at Church attendance? ______________ Are you in a regular Reunion Group? ____________

Are you regular in Ultreya attendance? ______________ Are you observing a rule of life? ________________

If spouse is applying check one or both: ______ Willing to serve together on a team.

______ Will serve separately on a team.

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(Please use back side for overflow)

Cursillo # / Diocese / Year Assignment/Position Rollo Given

1. ______________________________________________________________________________________

2. ______________________________________________________________________________________

3. ______________________________________________________________________________________

4. ______________________________________________________________________________________

5. ______________________________________________________________________________________

Other information: _________________________________________________________________________

________________________________________________________________________________________

Do you play a musical instrument? ____________________________________________________________

Other Cursillo leadership interest: ___ Servant community ___ Secretariat ___ Others ___________________

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Your signature: __________________________________________________ Date: ___________________

Your Parish Priest’s signature: ______________________________________ Date: ___________________

Please return to convocational contact person:

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