Address of Parish/Institution *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are the Candidates fully initiated Catholics of at least 18 years of age? *

ie. Baptism, Eucharist, Confirmation

Yes

Are the Candidates practicing Catholics in good standing with the Church? *

Yes

I verify that as Pastor I will provide adequate training for appointed Extraordinary Ministers of Holy Communion. *

Yes

Date *

MM

DD

YYYY

1. Name *

First Name

Last Name

1. Type of EMHC *

How will this person be serving as an extraordinary minister of holy communion?

Within Mass

Outside of Mass

Exposition/Reposition

2. Name

First Name

Last Name

2. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

3. Name

First Name

Last Name

3. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

4. Name

First Name

Last Name

4. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

5. Name

First Name

Last Name

5. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

6. Name

First Name

Last Name

6. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

7. Name

First Name

Last Name

7. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

8. Name

First Name

Last Name

8. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

9. Name

First Name

Last Name

9. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

10. Name

First Name

Last Name

10. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

11. Name

First Name

Last Name

11. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

12. Name

First Name

Last Name

12. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

13. Name

First Name

Last Name

13. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

14. Name

First Name

Last Name

14. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

15. Name

First Name

Last Name

15. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

16. Name

First Name

Last Name

16. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

17. Name

First Name

Last Name

17. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

18. Name

First Name

Last Name

18. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

19. Name

First Name

Last Name

19. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition

20. Name

First Name

Last Name

20. Type of EMHC

Within Mass

Outside of Mass

Exposition/Reposition