On Leave from Call Status Form
Are you Word & Sacrament or Word & Service?
Word & Sacrament
Word & Service
Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of Ordination/Consecration/Commissioning
-
Month
-
Day
Year
Date
Congregation/agency where you last served under call. (Or where you are serving if applying for initial OLFC status.)
Last day of active ministry in the congregation/agency.
-
Month
-
Day
Year
Date
What type of leave are you requesting?
Study
Family Leave
Other
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Reasons for requesting OLFC status (If you are requesting Family Leave, please include the names and ages of children or dependents in your care):
Would you be available for call to the NC Synod and the ELCA? If so, in what way?
Describe your ability and willingness to provide ministry services at the request of the bishop if on leave from call:
Describe your plans for continuing education during the coming year? (list areas of study and reasons):
When would you be available? Please use the link below to review ELCA guidelines for OLFC status.
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Month
-
Day
Year
Date
Link to OLFC Guidelines.
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In what congregation do you have membership? (An ELCA rostered leader must be an active member of an ELCA congregation.)
What is your involvement in the congregation where you hold membership?
Are you on the ordained roster, or intend to be, of any other church body?
Yes
No
If yes, which church body?
Do you intend to be supportive of the ELCA?
Yes
No
Are you a defendant in any pending civil or criminal litigation?
Yes
No
Have you been convicted of any criminal offense in the past 2 years?
Yes
No
Has anyone threatened to sue you within the past 2 years?
Yes
No
If YES to any of the last three questions, please state the nature, date & circumstances.
Submission Date
-
Month
-
Day
Year
Today's Date
Signature
Your typed name will suffice.
Submit
Should be Empty: