Personal Information

Please fill in the answers to each question.

First Name

Middle Name

Last Name

Birthday

Gender

Vocation

Current Address

Country

Address 1

Address 2

City

State

Zip Code

Phone Number

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.

Discipleship Wrap-up Retreat Information

Retreat Type

Nine Day Discipleship Retreat

Three Day Discipleship Wrap-up Retreat

Personal Discipleship Wrap-up Retreat

Other (provide explanation below)

Other Retreat Type

Year Completed

Where was your Discipleship Wrap-up Retreat completed?

Current Parish Information

Name of Parish

Location

Name of Pastor

Name of Diocese or Archdiocese

Name of Bishop or Archbishop

Ministries you serve in

Ministries asked to serve in by Pastor and/or Bishop

DJM Core Group Questions

Have you ever served on a DJM Core Group?

Are you currently serving on a DJM Core Group?

Where is your Core Group located?

What team(s) do you serve on as a servant coordinator or assistant?

Where was the Core Group located that you previously served on?

Reason for Leaving Core Group

Date of Leave of Absence or Resignation

Final Questions

Other ways you have participated in DJM?

If you would like to leave a brief testimonial on how DJM has affected your life, please add it here.

Agree to the terms of useThis Notice and Consent Statement is to inform you that DJM Ministries, Inc., may share information you provide in the DJM Family Census Form you have been asked to complete voluntarily. Any such exchange of information would be limited to DJM Ministries Inc’s business with our Catholic Church partners. It also helps us to evaluate and improve DJM Ministries, Inc., services to our members by better understanding our membership’s needs, geographic locations, and other pertinent data. The personal information shared may include any of the information you are submitting on the DJM Family Census Form. Therefore, we seek your consent to release and exchange such personal information with our Catholic Church Partners.
‍
DJM Ministries Inc. does NOT sell or exchange the DJM Family Census Form information with any other groups or individuals. DJM Ministries Inc. adheres to the Privacy laws of all the States and Countries within which we have our ministry Formation, and takes appropriate measures to protect your information.

DJM CONSENT: Please read this document carefully and submit the information below by pressing the Submit Button to confirm your understanding and agreement.

By pressing the electronic “SUBMIT” button below, I consent to DJM Ministries, Inc., releasing or exchanging all information I have submitted on the DJM Family Census Form with our Catholic Church Partners for the purposes described in the paragraph above. I confirm that any information I provide to DJM Ministries, Inc., is true and accurate to the best of my knowledge and that I have read this document and I understand its terms. I also submit this information of my own free will.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

DJM Family Census

Personal Information

Learn more about our
Formation Program here

Contact Us

Personal Information

Current Address

Initial Formation Information

Discipleship Wrap-up Retreat Information

Current Parish Information

DJM Core Group Questions

Final Questions

Learn more about our Formation Program here

Contact Us

Learn more about our
Formation Program here