Within the Roman Catholic Diocese of Syracuse
|Catholic Deaf Community of the Syracuse Diocese
1119 Elm Street
Utica NY 13501
As the Catholic Deaf Ministry of the Syracuse Diocese continues its
mission, we need to identify whom we will serve, where they live, and the
services they need. The result will be kept confidential, but will be used
to make decisions about how best to serve the Catholic Deaf and Hard-of-Hearing
within the Diocese of Syracuse. We ask you to complete this form and return
it as soon as possible. You can print it out, fill it in by hand and mail
to us; or copy all the text into your e-mail program, set your keyboard
to typeover and fill in the info, and e-mail to firstname.lastname@example.org. If there's
an annoying frame up at the top of this page, hit your right mouse button
and select "open page in new frame" or similar thing..
(Please X for each)
Name Date of Birth Deaf / H-of-H / Hearing
TELEPHONE: (Voice or TTY?)
Do you regularly attend Mass? YES NO
Does your parish offer any services for the Deaf/Hard of Hearing? YES NO
Is there anyone you know who is qualified to interpret any liturgies for our Catholic services and/or programs?
Does anyone in the family wish preparation for any of the following sacraments?
In what other areas do you have an interest or a need?
_____ Religious Education _____ Bible Study
_____ Engaged Encounter _____ Marriage Encounter _____ Formation for Ministry Program
_____ Cursillo _____ Pastoral Care (hospitals/homebound, etc.)
_____ Natural Family Planning instruction Other:
Do you know of any deaf or H-of-H persons in hospitals or nursing homes of whom we should be aware?
How do you wish to contribute to the life of the parish community: (e.g. lector (reader), eucharistic minister, catechist (teacher), usher, parish council, etc.)
How far would you be willing to travel to have Deaf Services available (circle one)
10-15 miles 15-20 miles over 20 miles Wish to stay
in home parish
If you know of anyone who has not received this form and would like
to be included in the results, please add their name and address here:
Thank you for sharing this info with us!!
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