Clergy Annual Status Report Form 2025

To be prepared and sent to the Bishop of the Diocese of Ohio
(Pursuant to Canon 1.6.2 of the Canons of the Episcopal Church)

Name:*

Home Address:*

City:*

State/Zip:*

Home Phone:

Format: (000) 000-0000.

Contact Phone:

Format: (000) 000-0000.

Cell Phone:

Format: (000) 000-0000.

Email:

example@example.com

ParochialNon-parochialSpecializedRetired

I am a Canonical Resident of The Diocese of:*

YesNo

If yes, where:

YesNo

If assisting, at what congregation(s) and how:

Congregation where I primarily worship:*

YesNo

If yes, where: Diocese of

Date of License:

Date

YesNo

If yes, please explain:

I completed the training listed below during 2025**I did not have any of the training listed below in during 2025

**Please upload or forward copy of training certificates for our files**

1. Safe Church Date:

Date

Location:

3. Title IV (Ecclesiastical Discipline) Date:

Date

Location:

2. Anti-Racism Date:

Date

Other:

4. Other Date:

Date

Location:

On the next page, please list official acts performed during this past year.

Rows	Official Act (acts typically recorded in parish registers) Example: Holy Eucharist, Funeral, Wedding	Where Performed	Number
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