Charge Conference Data Collection and Reporting Form
Date of Charge Conference
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Church
*
District
Please Select
Asheboro
Burlington
Clinton
Concord
Crystal Coast
Edenton
Fayetteville
Gastonia
Goldsboro
Great Smoky Mountain
Greensboro
Hickory
High Country
Mooresville
New Bern
Pembroke
Raleigh
Roanoke Rapids
Siler City
Statesville
Washington
Wilmington
Winston-Salem
Presiding Elder
*
Pastor Name
*
Pastor Contact Information
Name
*
First Name
Last Name
Email (personal)
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Conference Email
*
example@example.com
Non-Church Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Full Time Equivalent
.25%
.50%
.75%
100%
Physical Address (if different from mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church
Email
example@example.com
Office Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address (if different from mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church Membership?
Average in person attendance?
Website
Is this a Multi-church charge
Please Select
Yes
No
Other Church Name
Other Church District
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Associate Pastor(s)
Does the Church have an Associate Pastor
Yes (If Yes, complete below)
No (If No, go to next section "Church Leadership Reports")
Associate Pastor #1
First Name
Last Name
Full Time Equivalent
.25%
.50%
.75%
100%
Associate Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Associate Pastor's Conference Email
example@example.com
Associate Pastor's Personal Email
example@example.com
Associate Pastor's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Physical Address (if different from mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Emergency Contact
First Name
Last Name
Associate Pastor's Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Associate Pastor 2
Yes
No
Associate Pastor #2
First Name
Last Name
Full Time Equivalent
.25%
.50%
.75%
100%
Associate Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Associate Pastor's Conference Email
example@example.com
Associate Pastor's Personal Email
example@example.com
Associate Pastor's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Emergency Contact
First Name
Last Name
Associate Pastor's Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Associate Pastor 3
Yes
No
Associate Pastor #3
First Name
Last Name
Full Time Equivalent
.25%
.50%
.75%
100%
Associate Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Associate Pastor's Conference Email
example@example.com
Associate Pastor's Personal Email
example@example.com
Associate Pastor's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Emergency Contact
First Name
Last Name
Associate Pastor's Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Associate Pastor 4
Yes
No
Associate Pastor #4
First Name
Last Name
Full Time Equivalent
.25%
.50%
.75%
100%
Associate Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Associate Pastor's Conference Email
example@example.com
Associate Pastor's Personal Email
example@example.com
Associate Pastor's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Emergency Contact
First Name
Last Name
Associate Pastor's Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Associate Pastor 5
Yes
No
Associate Pastor #5
First Name
Last Name
Full Time Equivalent
.25%
.50%
.75%
100%
Associate Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Associate Pastor's Conference Email
example@example.com
Associate Pastor's Personal Email
example@example.com
Associate Pastor's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Associate Pastor's Emergency Contact
First Name
Last Name
Associate Pastor's Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Church Leadership Reports
Administrative Council Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Lay Leader(s)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Lay Leader 2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
SPRC/PPRC Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Treasurer
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Finance Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Trustee Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Women's Ministry
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Men's Ministry
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Youth Ministry
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Children's Ministry
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Evangelism Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Missions Chair
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Prayer Point Person
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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Lay Member Annual Conference Delegates
Each Church shall be entitled to as many Lay Members as it has APPOINTED Clergy
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add another Conference Lay Member?
*
Please Select
Yes
No
Annual Conference Lay Member 2
Lay Member #2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add another Conference Lay Member?
Please Select
Yes
No
Lay Member #3
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add another Conference Lay Member?
Please Select
Yes
No
Lay Member #4
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add another Conference Lay Member?
Please Select
Yes
No
Lay Member #5
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Does the Church have a Reserve Conference Lay Member(s) ?
Please Select
Yes
No
Reserve Lay Member Annual Conference Delegates
Reserve Lay Member 1
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Add Another Reserve Lay Member
*
Yes
No
Reserve Lay Member 2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add another Reserve Lay Member
Please Select
Yes
No
Reserve Lay Member 3
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add Another Reserve Lay Member
Yes
No
Reserve Lay Member 4
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add Another Reserve Lay Member
Yes
No
Reserve Lay Member 5
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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Pastoral Compensation
Base Salary
Accountable Reimbursement
Housing Allowance
Housing Exclusion
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Candidates for Ordained Ministry
Candidate 1
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add Another Candidate?
Please Select
Yes
No
Name of Candidate 2
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add Another Candidate?
Please Select
Yes
No
Name of Candidate 3
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Add Another Candidate?
Please Select
Yes
No
Name of Candidate 4
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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Extensions Ministers Connected to this Charge Conference
Please list those in Extension Ministry who are connected to NC Conference through your Charge Conference.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Extension Ministers associated with your church?
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Certified Lay Minister Information
Certified Lay Minister 1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Certified Lay Minister?
Yes
No
Certified Lay Minister 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Certified Lay Minister?
Yes
No
Certified Lay Minister 3
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Certified Lay Minister?
Yes
No
Certified Lay Minister 4
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Add another Certified Lay Minister?
Yes
No
Certified Lay Minister 5
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Submitted by:
First Name
Last Name
Position
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Has the church completed the Federal I-9 form for the Pastor?
Yes
No
Save
Submit
Should be Empty: