Section I

Name

Preferred Pronouns

She, Her, Hers
He, Him, His
They, Their, Theirs
Other

If you selected "Other," please specify.

Primary Email

Secondary Email

Personal Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

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

Are you retired?

For Inactive Retired Clergy: The Committee on Ministry may grant Inactive Retired status to a retired minister who applies for this status. Inactive Retired clergy continue to have standing as clergy and continue to be listed in the Minister's Directories online and in the Year Book clergy section. Inactive Retired clergy are exempt from completing the annual Ministerial Standing Renewal Form, including all continuing education requirements. Please apply for Inactive Retired clergy status ONLY if you are retired and no longer intend to engage in ministry, using this form: Inactive Retired Clergy Standing Application.

Emergency Contact Name

Emergency Contact Email

Emergency Contact Phone Number

Section II

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

Additional information on Professional Development and Continuing Education requirements and suggested activities to meet these requirements can be found here.

In order to maintain Standing with the Christian Church (Disciples of Christ) in the Upper Midwest, each minister 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.

Boundary Training

All clergy, except Inactive Retired clergy, are required to complete Boundary Training regularly. 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

All clergy, except Inactive Retired clergy, are required to complete an anti-racism or pro-reconciliation experience each year. This experience must be one quarter of the total required continuing education hours for the 2022 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 2022. Please list the number of hours for each training activity:

2022 Minister's Institute (6 hours maximum)

All Congregational Gathering (2 hours maximum)

CMEP or Seminary Classes

CPE Unit

Continuing Education such as Workshops, Seminars, Studies (list date completed and host organizations).

How did you complete the Anti-Racism Experience (please list the activity, the hours, and the setting)

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

Most Recent 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.

Total Continuing Hours

Section IV

Please describe your activities in the following groups:

Cluster

Regional Church

General Church

Ecumenical Group

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.