App 12.1 Application: Request to Return to Full Time Service Name: Address:
______________________________________________________________________ First Middle Last ______________________________________________________________________ Street City State Zip
Best Contact # (______)________‐__________ Birthdate: [__] Cell [__] Home [__] Work
_________ _________ __________ Month Day Year
Email:
______________________________________________________________________
Clergy Status: District:
[__] Full Elder [__] Full Deacon [__] Associate Member [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR
Charge:
______________________________________________________________________
I am currently serving:
[__] 1/4 time
[__] 1/2 time
[__] 3/4 time
Reason for requesting to return to Full Time Service: After having previously requesting less than full‐time service status, I now believe that I am ready to return to full‐ time service in the annual conference. I request to be returned to full time status as of:
_________ _________ __________ Month Day Year
Attach a written statement explaining why you requested a less than full time status and why you now feel that you are ready to come back into full time service. Your request will be submitted to the Conference Relations Committee (CRC) and an interview with that committee will be scheduled prior to the Board of Ordained Ministry (BOM) voting on your request.
__________________________ Signature
_________________________ Printed Name
___________________ Date
_____________________________________________________________________________________ Office Use: Request [__] was / [__] was not granted. Request Granted: ______ _____ 20______ Becomes Effective: ______ _____ 20______ Month Day Year Month Day Year
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org 1 of 1
Updated: 2022-11