Extension Ministries Form

APPOINTMENTS TO EXTENSION MINISTRIES ¶343,344.1a, b, c, d Book of Discipline

This information will be distributed to the Bishop’s office, your district superintendent, the Bishop of area in which you work if outside Indiana and copies of this report may also be used to inform the General Board of Higher Education and Ministry and the Charge Conferences(s) of which you are a member and an affiliate in keeping with ¶ 334.2a,b.

*First Name
*Last Name
*Email
*Membership
Full Member
Provisional Member
Associate Member
Local Pastor
Probationary Member
Employed at:
Title
Work address:
Work phone and fax:
Work email address:
Nature of work:
Date entered into Appointment to Extension Ministry
Home address:
Home phone and fax:
Cell phone:
Home email address:
Name of Charge Conference:
Charge Conference address:
Pastor's name
What responsibilities do you have in the church?
Are you a member of a Clergy Covenant Group now?
Yes
No
No answer
If so, does it have other UM clergy in it?
Yes
No
No answer
Is this group giving you the support you need?
Yes
No
No answer
Have you made the required report to your charge conference?
Yes
No
No answer
Number of weddings:
Number of baptisms:
Number of funerals:
Are you faithful in worship and stewardship?
Yes
No
No answer
What preaching have you done?
Have you celebrated Holy Communion?
Yes
No
No answer
How many times?
Narrative of ministry

Please include a brief narrative of your ministry during the past year including acts of ministry to the Christian community, description of annual evaluation and evidence of continuing education and spiritual growth.

Current Appointment Classification (344.1, Discipline)

Please select from the list.

Status of Appointment
Do you wish a change in status?

If yes, please contact Board of Ordained Ministry

Yes
No
No answer
Do you request to be continued as an Appointment to Extension Ministry?
Yes
No
No answer
Conference Secretary Data for Conference Journal (ΒΆ 606)
Base Salary:

Please report amounts for LAST CALENDAR YEAR

Travel allowance:

Please report amounts for LAST CALENDAR YEAR

Travel by voucher?
Yes
No
No answer
Housing/Utilities:

Please report amounts for LAST CALENDAR YEAR

Parsonage
Yes
No
No answer
Other income:
Health insurance
Yes
No
No answer
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