Review of Ministry: Active 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*

Serving in a local church as solo pastor
Serving in a local church as senior pastor (head of staff with multiple clergy called/employed by the church present)
Serving in a local church as associate pastor (called/contracted clergyperson, not serving as head of staff)
Serving in a local church as interim pastor
Serving in a specialized ministry setting outside of the local church
Leave of Absence - between calls and/or doing occasional service (supply, bridge, etc)
Leave of Absence - vocational discernment without any ministry engagement
Retired status
I hold Exempt Standing

Name of my ministry setting*

Address of ministry setting*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am in a*

My covenantal Association is*

Date of ordination/authorization in UCC*

If exact date is unknown, choose last day of appropriate month & year

My authorization for ministry is*

I hold an ecclesiastical endorsement*

Name of professional organization*

Name of military branch*

Date of endorsement*