Review of Ministry: Retired Status

Personal Information
Please include your pertinent contact details
Name*
First Middle Last
Mailing address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home phone
Leave BLANK if none
Mobile phone
Leave BLANK if none
Email*

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*
Effective date of your Retirement*
If exact date is unknown, choose last day of appropriate month & year
MM slash DD slash YYYY
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*

Personal Information