App 13 Application: Request to Continue Previously Approved Voluntary Leave of Absence (VLOA) Status Name: Address:
______________________________________________________________________
First
Middle
Street
City
Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work Email: Clergy Status: District: Charge:
Last
______________________________________________________________________ Birthdate:
State
_________ _________ __________ Month
Day
Year
______________________________________________________________________ [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR ______________________________________________________________________
Having been previously approved, I would like to request that I remain on: Date original VLOA became effective: Please note:
Zip
_________ _________ __________ Month Day Year
[__] Personal LOA [__] Family LOA
Failure to request annual extension via submission of this Application may invoke the Action of BOD ¶353.12 and result in your being placed on administrative location (¶359).
(Please remember that this request should be submitted by January 1st of each calendar year.) __________________________ Signature
_________________________ Printed Name
___________________ Date
Office Use: Date BOMEC/BOM approved request: _________ _________ __________ Month Day Year Annual Conference Clergy Session __________ [__] did / [__] did not approve this request. AC Year
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org [__] DCOM 1 of 1
Updated: 2020-11