App 16 Application: Sabbatical Leave (¶351) Name: Address:
______________________________________________________________________
First
Middle
Last
______________________________________________________________________ Street
City
State
Zip
Best Contact # (______)________-__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________
[__] I confirm I have been serving in a full-time appointment for six years (or the equivalent thereof in a part-time appointment) since I came into Full Membership / Connection with the annual conference. [__] Current Clergy Status: [__] Full Elder [__] Full Deacon [__] Associate Member [__] Date I came into Full Membership: _________ _________ __________ Month
Day
Year
[__] The length of time I seek to engage in a Sabbatical Leave: _____________ months (12 month maximum) [__] If approved, the date on which the Sabbatical Leave should start and end are: _________ _________ __________ End: _________ _________ __________ Start: Month
Day
Year
Month
Day
Year
[__] I understand that up on completion of this Sabbatical Leave, that it is not guaranteed that I will return to service at the same compensation level as I was when Sabbatical Leave began. [__] This is the first Sabbatical Leave for which I have applied. Having given careful thought and prayer, I hereby request that the Board of Ordained Ministry (BOM) consider my request for Sabbatical Leave (¶351). • This request must be submitted 6 months prior to the start of the next scheduled annual conference. December 1st is an appropriate date to meet this deadline requirement. • Submit a detailed description of your proposed program of study or travel and how you feel this will strengthen your ministry or your relationship with God.
__________________________ _________________________ ___________________ Signature Printed Name Date _____________________________________________________________________________________ Please submit copies of this application to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Director of Clergy Services via ClergyServices@holston.org [__] Current District Superintendent Office Use: Episcopal Office approved request: Date BOMEC/BOM approved request:
Month Day Year _________ _________ __________ _________ _________ __________
Updated: 2020-11