Form 15 Supply Preacher (SY) Supervisory Agreement with the District Superintendent Name:
______________________________________________________________________
First
Address:
Middle
Last
______________________________________________________________________ Street
City
Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work Email:
Birthdate:
State
Zip
_________ _________ __________ Month
Day
Year
______________________________________________________________________
As a Supply Pastor, I have been asked to serve the following: District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge Church 1
Church 2
Street
Street
City
City
State Zip
State Zip
Worship Time Frequency
Worship Time Frequency
Church 3
Weekly Monthly
Bi-weekly
Church 4
Street
Street
City
City
State Zip
State Zip
Worship Time Frequency
Weekly Monthly
Bi-weekly
Worship Time Frequency
Weekly Monthly
Bi-weekly
Weekly Monthly
Bi-weekly
Please submit to: [__] The Office of Clergy Services via ClergyServices@holston.org [__] DCOM [__] Supervisory file at the District Superintendent’s office 1 of 2
Updated: 2020-11