Section I

Name

Spouse/Partner Name

Personal Email

Work Email

Personal Phone Number

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Phone Type

Cell
Work
Home

Alternate Phone Number

Alternate Phone Type

Cell
Work
Home

Additional Alternate Phone Number

Additional Alternate Phone Type

Cell
Work
Home

Home Address

Church Membership (Name and Location)

Are You Ordained or Commissioned?

Ordained
Commissioned

Ordination/Commissioning Date

Ordination/Commissioning Region

Do you consider yourself retired?

If so, are you Active or Inactive Retired

Active
Engaged in ministry at this time.
Inactive
Not engaged in ministry at this time. (In order to enter into any form of ministry again, your status as Inactive Retired must be adjusted first.)

What year did you begin ministry in the Upper Midwest?

What is your highest degree earned?

Section II

If you are Inactive Retired, please skip to Section IV.

When did you begin your current ministry?

What it your current FTE?

Are you bi-vocational?

If so, please list your second profession.

What is your current ministry site? (Name and Location)

What is your title for this current ministry?

What is it about your ministry this past year that has reconfirmed your call to ministry?

On a scale of 1-10 (10 being the most healthy), how do you understand the health of your ministry?

Please explain why:

On a scale of 1-10 (10 being the most healthy), how is the health of your congregation/ministry site?

Please explain why:

Section III

In order to maintain Standing with the Christian Church (Disciples of Christ) in the Upper Midwest, each pastor must complete the following hours of continuing education:

Full Time Clergy - 16 hours
3/4 Time Clergy - 12 hours
1/2 Time Clergy - 8 hours
1/4 Time Clergy - 4 hours

Classroom or Seminar studies = 1 CEU per 50 minute contact period. Self-guided study is also acceptable. Reading a book, approximately 250 page = 1 credit hour.

Boundary Training

All clergy, except Inactive Retired clergy, are required to complete Boundary Training. The Upper Midwest Region requires all new clergy to complete an initial course either at the time at which they enter into ministry or move to the Upper Midwest Region. After completing their initial course, clergy are required to complete a refresher course in the years 2020, 2025, 2030, 2035, etc.

Anti-Racism/Pro-Reconciliation Experience

Beginning with the 2020 calendar year, all clergy, except Inactive Retired clergy, are required to complete an anti-racism or pro-reconciliation experience. This experience must be 4 of the 16 total required continuing education hours for the 2020 calendar year. (The required number of hours is pro-rated based on the clergy's FTE. For example, .5 FTE = 2 hours.)

List your continuing education hours for 2020. Please list the number of hours for each training activity:

2020 Minister's Institute (record 14 hours)

If you did not attend Minister's Institute, how did you complete the Anti-Racism Experience (please list the activity and the hours)

Please describe the insights or impact the anti-racism experience you completed had for you and your ministry.

All Congregational Gathering

CMEP or Seminary Classes

CPE Unit

Boundary Training (list date completed and host organization)

Self-guided study (may be used as 1/2 required hours) List titles or book(s) and hours.

All other continuing education completed (list with hours)

Total Continuing Hours

Section IV

Please describe your activities in the following groups:

Cluster

Regional Church

General Church

Ecumenical Group

Which Upper Midwest Cluster do you attend or associate?

Are there areas within the regional church in which you would like to be more involved?

Are you interested in being included on the region's pulpit supply list?

Section V

Are you willing to be a faithful minister serving within and supportive of the Christian Church (Disciples of Christ)?

All clergy with standing in the Christian Church (Disciples of Christ) are required to read, understand, and agree to abide by the following ministry policies of the region (available upon request through the Regional Office or at https://www.uppermidwestcc.org/for-clergy):

Ministerial Code of Ethics
Policies and Criteria for the Order of Ministry
Regional Policy on Clergy Sexual and Ethical Conduct
Design for the Christian Church (Disciples of Christ)

Furthermore, all clergy with standing should understand that these are the operational documents for the Region's Committee on Ministry and are the documents used by the Executive Unit in determining ministerial standing.

I agree to abide by the above policies of the Region.

Personal Disclosure Statement

Have you ever been charged with or convicted of a felony?

Have you ever been charged with or convicted of any crime against children or other persons?

Is there any other fact or circumstance in your background that should prevent you from being entrusted with the supervision, guidance, and care of children or youth?

If you answered "yes" to any of the above personal disclosures, please explain here:

By typing my name here, I confirm my desire to apply for standing and certify that the information provided above is accurate.