Review of Ministry: Leave of Absence Status

Preferred Dates to meet with COM-B (please list three, in order of preference)*
Ministerial Authorization & Local Church
Please include details of your current authorization for ministry, vocational engagement, and Local Church membership
The NCNC-UCC Local Church in which I hold my membership is*
Currently, my primary ministry work is*
- Leave of Absence - between calls and/or doing occasional service (supply, bridge, etc)
- Leave of Absence - vocational discernment without any ministry engagement
Name of my employer, if applicable
Address of employer, if applicable
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Effective date of Leave of Absence*
MM slash DD slash YYYY

If exact date is unknown, choose last day of appropriate month & year
Date of ordination/authorization in UCC*
If exact date is unknown, choose last day of appropriate month & year
MM slash DD slash YYYY
My authorization for ministry is*
I hold an ecclesiastical endorsement*
- No
- Yes: for a professional organization
- Yes: for military chaplaincy
Name of professional organization*
Name of military branch*
Date of endorsement*
MM slash DD slash YYYY

Personal Information