Application for 2023-2025 IMPACT Cohort

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Primary Email Address REQUIRED Please fill out this field. Please enter an email address.

Alternate Email Address (Optional) Please enter an email address.

Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Alternate Phone Number (Optional) Please enter a phone number.

Gender REQUIRED Male Female Please fill out this field.

Age Demographic REQUIRED Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75 or older Please fill out this field.

Marital Status REQUIRED Single, never married Married Divorced Widowed Please fill out this field.

How long have you been Catholic? REQUIRED Please fill out this field. Please enter valid data.

Parish/Cluster Name REQUIRED Please fill out this field. Please enter valid data.

Parish/Cluster Location REQUIRED Please fill out this field. Please enter valid data.

Have you discussed your interest in participating in IMPACT with your parish pastor or PLC? REQUIRED Yes No Please fill out this field.

Are you an employee of your parish/cluster, or of the Archdiocese of Dubuque? REQUIRED Yes No Please fill out this field.

If yes, what is your role/title? Please enter valid data.

If not, what is your occupation? Please enter valid data.

In what ways are you involved in your parish/cluster community? REQUIRED Please fill out this field.

How would you describe your present relationship with God and how do you live out your relationship with God in your daily life? REQUIRED Please fill out this field.

After reviewing the information about IMPACT on the website, what are two or three reasons for wanting to be a part of this program? REQUIRED Please fill out this field.

Is there anything more about you or your faith journey you would like us to know?

How did you hear about the IMPACT program? REQUIRED Friend Pastor or PLC Parish Bulletin Lay Formation Alumni IMPACT Alumni Brochure Other Please fill out this field.

If other, please specify: Please enter valid data.

Please review the following Expectations of Applicants and Click "I Agree" if you can commit to them:

- Commit to growing in your faith in an exciting environment!
- Commit to participating in all monthly sessions (if you must be absent, you will view recordings of the sessions online) and the Year 1 opening retreat weekend.
-Commit to completing the required reading, reflection papers, and other assigned work.
-Seek a recommendation from your pastor or parish life coordinator (PLC).
- Seek financial support from your parish through the pastor/PLC. Parishes typically pay for half ($150 per year) of the registration fee.

Expectations of Participants after Acceptance:

- Obtain a spiritual mentor and commit to meeting with them once a month (September through May).
- Be willing to share with your pastoral council each year while in the program to discuss your journey.
- Meet with your pastor/parish life coordinator (PLC) near the end of the IMPACT program to discuss possibilities for enhanced or new involvement in the parish.
- Acquire assigned books. The book list will be sent with the acceptance letter.
- Pay for your portion of the registration fee. After your application has been approved, you will then be asked to pay the Year 1 fee online or by check. If your parish/cluster is sponsoring you by paying half of the cost, you will be responsible for paying $150 (half of the total cost) per year (plus purchasing the required books). An Archdiocesan grant is available to cover this portion of the cost for parish/cluster employees.

Please check the following box if you accept the above expectations. This is required in order to be able to submit your application.

I Agree to the Expectations Please select this field.

Application for 2023-2025 IMPACT Cohort

For questions or more information, contact:

2023-2025 IMPACT Cohort Application Form