The United Methodist Church
Annual Report of Clergy Member on Leave of Absence
First Name
*
Middle
Last Name
*
Address
City
State
Zip
Home Phone
Office Phone
Mobile Phone
E-mail Address
*
Birthdate
-
Month
-
Day
Year
Date Picker Icon
Conference
District
*
Please Select
Central
East
New Church Start
North
South
West
Conference Membership
Deacon in Full Connection
Elder in Full Connection
Provisional Member
Associate Member
Last appointment served in what district
Number of years on leave of absence (including this year) ***Note*** When clergy members do not request an extension of the leave of absence annually, or do not indicate willingness to itinerate at the end of the five-year period, provisions of location (¶359) or the complaint procedures of ¶363 may be invoked.
Present occupation
Do you desire to request an end to your leave of absence at the next session of the annual conference? If yes, provide your reasons for this request below.***Note*** Clergy members seeking to end their leave of absence with an appointment by the bishop must submit their written request to the Board of Ordained Ministry and cabinet six months prior to the session of the annual conference (¶354.11).
No
Other
Do you desire to request an extension of your leave of absence for the coming appointment year? ***Note*** Clergy members requesting an extension to their leave must do so by written request (¶354.1).
No
Other
Please attach a copy of your report to the charge conference regarding performances of ministerial duties.
Performance of ministerial duties
Name
Date
SUBMISSION OF THIS FORM DOES NOT PROVIDE A COPY TO, OR EXPRESS YOUR DESIRE TO EXTEND OR END YOUR LEAVE OF ABSENCE TO:
1. The Board of Ordained Ministry
2. Your District Superintendent
3. The Bishop's office
Submit
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