Fourth Degree Membership Application (Form 4)

Fourth Degree Membership Application — Form 4

Second New Jersey District · Knights of Columbus

Complete the membership information below. Applicants and authorized assembly officers will be able to use the online application once the submission system is activated.

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1. Completed By

Who is completing this form?

Officer name (if applicable)

Officer email (if applicable)

2. Applicant Information

Last name

First name

Middle initial

Title

Street address

City

State / Province

Postal code / Country

Home phone

Date of birth

Marital status

Citizenship — country

Citizenship acquired by

Final naturalization papers received?

3. Membership Information

Membership number

First Degree date

Council number — searchable list to be connected

Council name (populated after selection)

Assembly number — searchable list to be connected

Assembly name (populated after selection)

Application type

Parish name

Parish affiliation

4. Previous Fourth Degree Membership (if applicable)

Previous initiation date

Termination date

Previous assembly number

Previous assembly city

Previous assembly state / province

Reason for termination

5. Proposer and Council Verification

Proposer full name

Proposer membership number

Proposer assembly

Council location

Financial Secretary name (to be linked to council)

Financial Secretary email (to be linked to council)

6. Assembly Officer Routing

Faithful Navigator name (to be linked to assembly)

Faithful Navigator email

Faithful Comptroller name (to be linked to assembly)

Faithful Comptroller email

The final application workflow will send individual signing links to the Financial Secretary, Faithful Navigator, and Faithful Comptroller simultaneously.

7. Applicant Declaration and Signatures

I hereby declare that the information provided is true and correct and that I am a practical Catholic in communion with the Holy See.

Applicant signature

Electronic signature or printable signature line — to be enabled.

Proposer signature

Electronic signature or printable signature line — to be enabled.

Officer signatures

Financial Secretary, Faithful Navigator and Faithful Comptroller will receive secure signing requests. Official Form 4 signature requirements will be verified before activation.

8. Application Processing

Upon submission: The District Master and Master’s Secretary will receive a pending-application notification. The three designated officers will receive signature requests.

After all required signatures: A completed Form 4 PDF will be sent to the District Master and Master’s Secretary, and the private membership tracking sheet will be updated.

Administrative processing fields, fees, initiation details and the Master’s signature remain part of the official Form 4 and will be handled in the final workflow.