Regional Minister Report Form

Christian Church (Disciples of Christ) of Mid-America
Regional Minister
Report Form

This form documents an initial Conversation between a Mid-America Regional Minister or Associate Regional Minister and an Individual interested in pursuing Commissioning or Ordination with the Christian Church (Disciples of Christ).
This Report is for a:*

Conversation with an Individual interested in pursuing Commissioning or Ordination.Referral for Commissioned Minister to begin "Commissioned Minister Track to Ordination."
Date of Meeting*

MonthDayYear
Date
Date of Referral*

MonthDayYear
Date
Individual's Name*

First NameLast Name
Commissioned Minister's Name*

First NameLast Name
Individual's Email*
example@example.com
Commissioned Minister's Email*
example@example.com
Regional Minister (RM) or Associate Regional Minister (ARM)*

Paul Koch, RMDavid Woodard, ARMAngela Williams, ARMJennifer Long, ARMOther
Regional Minister's Email*
example@example.com
Meeting Held*

In-PersonOver the Phonevia ZoomOther
Process Individual is Pursuing:*

Ordination: Seminary Track (RCOM)Ordination: Apprentice Track (RCOM)Recognition of Standing & Ordination (RCOM)UCC Partner Standing (RCOM)Commissioning Track (MDT)Other
Sponsoring Congregation
Supporting Congregation (if known)
Does this Individual already have a Mentor?*

YesNoOther
Mentor's Name (if known)

First NameLast Name
Mentor's Email (if known)
example@example.com
Official Referral to RCOM*
A detailed explanation for your referral of this Commissioned Minister to RCOM and why they should be considered for Ordination with the Christian Church (Disciples of Christ).
Meeting with Regional Minister
Meeting Summary*
A summary of the conversation between this individual and Regional Minister.
Affirmations*
Recommendations/Next Steps*
Regional Minister's recommendations and next steps for this Individual as they explore the Commissioning or an Ordination process.
Comments/Notes
Any additional important or relevant information.
Signature of Regional Minister: This completed form will be emailed to the Individual for approval.*

Clear
Signature of Regional Minister: This completed form will be emailed to the Commissioned Minister for approval.*

Clear
Should be Empty: