Parish Religion Education Program (PREP) Profile

Ministry Contact & Information Form
The Catechetics Office collects and protects the personal information on this form pursuant to the Personal Information Protection Act. The information will be used only for the purposes of assisting PREP Coordinators and Pastors in their program delivery and to promote the PREP program within the Archdioceses.
Parish Name*

Coordinator’s (main contact) Information
Name of Coordinators*
First Last
Email*
Day Phone*
Evening Phone*
Home Address*
Street Address Address Line 2 City Province Postal Code
Mailing Address
(if different from above)

Street Address Address Line 2 City Province Postal Code
How long have you been in this position?*
The information collected in this section is strictly for support and advocacy purposes and will be seen by Catechetics Office staff only:
Is your position a paid position?*
- Yes
- No, I am a volunteer
- Stipend Only

Program Information – For Publication
The information provided below will be utilized as a “PREP Coordinator’s Directory” and a listing for the public looking for a PREP program.

Consent to Publish:
In accordance with the Personal Information and Privacy Act, please read the following very carefully. We also need your signature below to affirm your consent. Please note: your name and ministry will be made public due to the nature of your ministry. Thank You.
I give consent to publish the following information on the Catechetics website*
- Yes
Affirmation of Consent*
(enter full name)
First Last
Date*
YYYY slash MM slash DD
PREP Program Contact Name*
First Last
PREP Program Contact Number*
PREP Program Contact Email*
PREP Fax Number
PREP Schedule
When are classes held?
Day of the Week*
Time*

: Hours

Minutes

AM/PM
Location (Name)*
Location Address*
Street Address Address Line 2 City Province Postal Code
First Day of Classes*
YYYY slash MM slash DD
Last Day of Classes*
YYYY slash MM slash DD

New? (Yes/No)	Name	Role	Grade	Phone	# of students

Ministry Contact & Information Form