Retired-Inactive Clergy Report Form

The Christian Church (Disciples of Christ) of Mid-America

Retired-Inactive Clergy
Report Form

Please complete this form to update your Clergy records as a "Retired-Inactive" Disciples of Christ (DOC) Minister with Standing in the Mid-America (CCMA) Region. This helps the Region ensure that your Clergy records remain current. If you are an "Active" or "Retired-Active" Minister, please instead complete both the Standing Renewal Report Form and Professional Development Report Form for the respective reporting year.

Should you have any questions, please contact your Ministry Associate in the Springfield Regional Office at sgf@ccmadisicples.org. Thank you so much!

Date

Title

Other

Full Name

First NameMiddle NameLast NameSuffix

Preferred Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Gender

Ethnicity

Date of Birth

Date

Status

Other

Official Date of Retirement

Previous Employment

Please list the last Ministerial Site (Congregation/Organization/Institution) that you served as a Minister or Chaplain (or other Ministerial capacity).

Previous Employment Position/Title

Please list the Position/Title held with your previous Ministerial Site (Congregation/Organization/Institution).

Previous Employment Beginning & End Dates

Please list the dates that your previous employment began and ended.

Other Previous Employment Information (if applicable)

Are you currently a Member of a DOC Congregation within the Mid-America Region?

Name & Location of Congregation where Membership is held.

Your Mid-America Regional Minister(s)

Have you been previously Commissioned/Licensed?

Original Date Commissioned/Licensed

Please list both the date that you were originally Commissioned/Licensed and the Denomination/Region that Commissioned/Licensed you.

Are you Ordained?

Ordination Date

Date

Ordination Region

If Ordained by another Denomination, please list the Disciples of Christ (DOC) Region that first recognized your Ordination.

Important Documents (if applicable)

The Mid-America Region will gladly store any important documents you want saved in your Clergy file. Please upload any applicable documents here. You are also welcome to take a picture of documents and text them to the Ministry Associate in the Springfield Regional Office at (417) 865-0850.

Additional Comments/Feedback (if applicable)

This field is optional.

Would you like the Regional Office to mail you a Standing Card for the reporting year?

I acknowledge my "Retired-Inactive" status as an Ordained Minister with Standing in the Mid-America Region. However, should I at any time decide to again become "Active" in Ministry, I will contact my Regional Minister or Ministry Associate in the Springfield Regional Office to begin the process of updating my Ministerial status and Standing. I understand that this will require me to complete annual standing forms and renew my Boundaries and Anti-Racism/Pro-Reconciliation Trainings (if they have not been taken in the past three years).