Visiting Clergy’s Details

Title

First Name *

Last Name *

Your current address *

No. and Street *

City *

State *

Postcode *

Email Address *

Phone Number *

Diocese / Order you belong *

Church Authority Name

Church Authority Email

Details of Retreat/Event within the Diocese of Maitland-Newcastle

Please provide the following information about your planned ministry within the Diocese of Maitland-Newcastle.

Nature of Proposed Ministry *

Commencement Date *

Conclusion Date *

Location of Proposed Ministry / Ministries *

Expected Recipients of Ministry / Ministries *

This is my only Proposed Ministry / Ministries *

Have you received permission from the Appropriate Parish Priest/s for your Proposed Ministry/Ministries? *

YesNo

Attach Permission from Parish Priest for you Proposed Ministry / Ministries *

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Evidence of Good Standing & Statutory Compliance

Please provide evidence of your canonical good standing and compliance (If there is no ACMR and no Church Authority Statement, the application cannot proceed).

I Possess an ACMR Number *

YesNo

Provide ACMR Number *

Please provide a Church Authority Statement *

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I have a current NSW WWCC or Application Number *

YesNo

Provide WWCC Number & Expiry *

Privacy Acknowledgement and Consent

By submitting this form, I acknowledge that the Catholic Diocese of Maitland‑Newcastle may collect, use, and disclose my personal information as required to carry out its functions and in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. I consent to my information being handled in this way and understand I may request access to or correction of my personal information.

Do you agree with the above statement *

Yes, I have read and understood the above statementNo, I have read and disagree with the above statement

Signature *

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