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 & 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*

Rev.Rev. Dr.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.

Gender

Ethnicity

Date of Birth*

Date

Status*

Retired-InactiveOther

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?*

YesNo

Name & Location of Congregation where Membership is held.*

Your Mid-America Regional Minister(s)*

Have you been previously Commissioned/Licensed?*

YesNo

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?*

YesNo

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?

Yes, please mail it to me at the address provided.Yes, please email it to me at the email address provided.No, thank you. I don't need one.

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).