Form 17 Acknowledgement & Acceptance: Less than Full-Time Appointment during the Provisional
Name: ________________________________________________________________________________ Address: ______________________________________________________________________________ Phone: (____) ______-________ Email address: ______________________________________________ I am currently on the [__] Elder [__] Deacon track. [__] I currently do not serve a church / charge OR [__] I currently serve the following: ________________________________________________ _____________________________________ Church / Charge District Superintendent is District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Seminary Information: _____________________________________ Seminary Name
_____________________ Graduation date
_________________________ Degree earned
It is the expectation that the cabinet will appoint all provisional members to full-time service. All provisional members have a maximum of 8 years from the year they enter the provisional process to complete the equivalent of 3 years full-time service before they can possibly enter into full connection and membership in the annual conference. After careful and prayerful conversation with my current district superintendent, I acknowledge my willingness to accept a less than full-time position for the annual conference year of _______ to _______. I understand that this will extend my time in the provisional process and that it could, ultimately, impact my ability to complete the provisional process within the required 8 years that are permitted. Signature:
I hereby certify that all the information I have provided is true and accurate.
__________________________________________ Signature of Provisional Member
__________________________ Date
__________________________________________ Signature of District Superintendent
__________________________ Date
Projection:
It is projected that the above named individual will be appointed to:
Church / Charge
[__] 1/4 Service Time
[__] 1/2
[__] 3/4
District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR
Please submit to: [__] The Office of Clergy Services via ClergyServices@holston.org 1 of 1
Updated: 2020-11