Retired-Inactive Clergy Information Form

Christian Church (Disciples of Christ) of Mid-America

Retired-Inactive Clergy Information Form
Please complete this form to update your Clergy records as a Retired-Inactive Disciples of Christ (DOC) Minister having Standing with 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 the Standing Renewal Report Form & Continuing Education 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

MonthDayYear
Date
Title*
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.
Gender
Ethnicity
Date of Birth*

MonthDayYear
Date
Status*

Retired-Inactive
Date of Retirement*

MonthDayYear
Date
Previous Employment*
Please list the last Congregation/Organization/Institution you served as Minister or Chaplain (or other applicable ministerial position).
Previous Employment Position*
Please list your Position/Title with your previous Congregation/Organization/Institution.
Previous Employment Beginning & End Dates*
Please list the dates your previous employment began and ended.
Are you currently a Member of a DOC Congregation within the Mid-America Region?*

YesNo
Name & Location of Congregation where Membership is held.*
Please indicate which Mid-America Regional Minister (RM) or Associate Regional Minister (ARM) you work with or have worked with in the past.*

Paul KochRon RoutledgePhil Snider, ARM Greater SpringfieldDavid Woodard, ARM Greater St. LouisNoneOther
Have you been previously Commissioned/Licensed?*

YesNo
If you have been previously Commissioned/Licensed: What was your original date of Commissioning/Licensing? And through which Denomination/Region?*
Please list both the date you were originally Commissioned/Licensed and the Denomination/Region that Commissioned/Licensed you.
Are you Ordained?*

YesNo
If Ordained, please provide your date of Ordination.*

MonthDayYear
Date
If Ordained: Please list the DOC Region where you were Ordained, or the date and DOC Region that recognized your Ordination if through another Denomination.*
The Mid-America Region is happy to store any important documents you would like to have in your clergy file. If you have documents or files that you would like stored in your clergy file with the Mid-America Region, please upload them 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.

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Additional Comments/Feedback:
Would you like the Regional Office to mail you a Standing Card for the reporting year?

Yes, please mail it to me.Yes, please email it to me.No, thank you.
I acknowledge that my Retired-Inactive Ministerial Standing indicates that I am not active in ministry. Should I decided to again become active in ministry, I will contact my Regional Minister or Ministry Associate in the Springfield Regional Office to reactivate my Ministerial 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).

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