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

My current status is:

I am a Canonical Resident of The Diocese of:

Currently Employed:

If yes, where:

Seeking Employment:

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

Congregation where I primarily worship:

I live outside the Diocese of Ohio and am licensed to officiate in the diocese where I live:

If yes, where: Diocese of

Date of License:

Date

Are you active in Diocesan or Clericus activities:

If yes, please explain:

**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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