Mid-Year Appointment Form/Change in Status Form 2023-2024

Mid-Year Appointment Form/Change in Status Form 2023-2024

This form is to be completed by District Superintendents/District Admins any time there is a clergy status change including a new appointment or change in an existing appointment:
District Superintendent Filling Out Form and District*

Coastal Virginia: Rev. Dr. Cecelia BrooksLiving Waters: Rev. Jay CareyMission Rivers: Rev. Dr. Charles Ledlum-BatesMountain View: Rev. Denise BatesNorthern Virginia: Rev. Dr. Sarah CalvertShenandoah River: Rev. Dr. Victor GomezThree Notch'd: Rev. Dr. Hyo LeeValley Ridge: Rev. Doug Forrester
D.S. Email/District Admin Email - a copy of this form will go to the email address in the box below:*
example@example.com
Name of Person Leaving Appointment or Changing Status*

PrefixFirst NameLast NameSuffix
Name of Spouse (if applicable)

First NameLast Name
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Cell Phone Number*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Office Phone Number
Please enter a valid phone number.
Reason for changing appointment or status*

1st time appointment in VAUMCChanging appointment mid-yearGoing on personal, transitional, family or medical leaveLeaving current appointment to go to a new appointmentEarly retirementDiscontinuedTerminatedWithdrawal by turning in credentialsWithdrawal to Unite with Another DenominationOther
Choose one:*

This person's conference relationship status will not be changing (skip previous conference relationship question below).This person's conference relationship will be changing, complete previous conference relationship and new conference relationship status questions below).
Previous Conference Relationship (if applicable):
If other, please specify:
Previous Appointment (if applicable)- This includes leave, retirement, MQ20 etc.
Is this a new person or someone who has already been serving in the VAUMC.*

New person.Has previously served in the VAUMC.
If this is a new person please share if they are coming to serve from another conference.
New Conference Relationship (if applicable):
New Appointment Position Title (if applicable)
Appointment Information
Name of Appointment (if applicable)
GCFA Number of New Appointment (if applicable)
What is this person's salary for this new appointment/change in status? (if applicable)
Percentage Appointed

25%50%75%100%N/A or Other
If you chose other please specify below:

What is the effective date this new status or appointment will begin?*

MonthDayYear
Date
Important Info: Please share any other important info for the Cabinet, Pensions Office, Communications Office, and the Office of Clergy Excellence:
Should be Empty:

Mid-Year Appointment Form/Change in Status Form 2023-2024

Appointment Information