Supplement to: DCOM / BOM Guidelines (2019 Edition) by Holston Annual Conference

Glossary of Acronyms Used by the Holston Annual Conference Board of Ordained Ministry (BOM) ALPS .................... Appalachia Local Pastors School ALPS‐MTH ........... Appalachia Local Pastors School‐Memphis‐Tennessee Holston AC ........................ Annual Conference ACOS ................... Advanced Course of Study AM ...................... Associate Member ANA ..................... Approved Not Appointed BAC ..................... Business of the Annual Conference BGTS.................... Basic Graduate Theological Studies BOD ..................... Book of Discipline BOM (BOOM) ...... Board of Ordained Ministry BOMEC ................ Board of Ordained Ministry Executive Committee CCLSM ................. Conference Committee on Lay Servant Ministry CLM or LM .......... Certified Lay Minister CLS ...................... Certified Lay Servant COS ..................... Course of Study CRC ...................... Conference Relations Committee DCOM (DCOOM) . District Committee on Ordained Ministry DS ........................ District Superintendent DSA ..................... District Superintendent Assign (aka‐Supply Preacher) EM360 ................. Effective Ministry 360 EYA ...................... Eight Year Assessment FD ........................ Full Deacon FC ........................ Full Connection FE ........................ Full Elder FTLP or FL ............ Full Time Local Pastor GBHEM ............... General Board of Higher Education and Ministry ICA ....................... Interim Change of Appointment JCML ................... Joint Committee on Medical Leave KSAP .................... Knowledge, Skills, Abilities, Personal Characteristics LOA ..................... Leave of Absence LSM ..................... Lay Servant Ministry LP ........................ Local Pastor LPLS ..................... Local Pastor Licensing School MAS .................... Ministerial Assessment Specialist MEF ..................... Ministerial Education Fund OE ....................... Other Methodist Denomination OF ....................... Other Fellowship (Denomination) PA ........................ Provisional Associate PD ....................... Provisional Deacon PE ........................ Provisional Elder PTLP or PL ........... Part Time Local Pastors RIM ..................... Residency in Ministry RA ....................... Retired Associate RD ....................... Retired Deacon RE ........................ Retired Elder RL ........................ Retired Local Pastor SEBTF .................. Sexual Ethics and Boundaries Task Force SG ........................ Safe Gatherings SY or SP ............... Supply Preacher VLOA ................... Voluntary Leave of Absence

Form 17

Acknowledgement & Acceptance: Less than Full-Time Appointment during the Provisional Process

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: [__] 1/4 [__] 1/2 [__] 3/4 Church / Charge Service Time

District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR A signed copy of this Form 17 is to be placed in the file of the named individual and a pdf emailed to the BOM Registrar at clergyservices@holston.org

Page 1 of 1 Provisional Member: _______________________________

FORM 17 rev. 3/20

Form 18

Declaration that Retiring Local Pastor ሺRLሻ has bet the criteria to be classified as a Retired Local Pastor ሺRLሻ

District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR After examination, the DCOM of the _____ District certifies that the above named pastor has met the criteria to be considered a Retired Local Pastor (RL). Specifically this pastor has (check one) [__] Completed Course of Study (COS): __________________________________________ Date of COS Completion [__] Not completed COS, but was making adequate progress towards completion at the time of retirement. Upon retirement, the above named pastor will become a member at the following: ___________________________________________________________________________________________ Church

District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Signature: I hereby certify that all the information I have provided is true and accurate. __________________________________ __________________________ __________________________ DCOM Registrar: Signature Printed name Date Copies: [__] Retain original in Local Pastor’s DCOM file [__] Email completed copy to ConferenceSecretary@holston.org

Application 09 Application to serve in the Holston Annual Conference as an Elder from other Annual Conference and other Wesleyan denominations (OE) Name:

______________________________________________________________________ First

Address:

Middle

Last

______________________________________________________________________ Street

Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work

City

Birthdate:

State

Zip

_________ _________ __________ Month

Day

Year

Email:

______________________________________________________________________

District:

[__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR

Having been ordained in a Methodist related denomination and now desiring to serve, after consultation with a District Superintendent, within the Holston Annual Conference, I affirm that I am willing “…to support and maintain United Methodist doctrine, discipline and polity.” I also agree to supply the following documents to the District Superintendent and Director of Clergy Services:

[__] A copy of my ordination certificate from my current denomination [__] A Notarized Disclosure Form: Form 16 (supplied by District Superintendent) [__] Take and Release Required Psychological Tests/Reports [__] Submit to a Background/Credit Check and receive Safe Gatherings Certification I realize, that my credentials may or may not meet the standards as set forth by the United Methodist Church and that I can serve without full recognition, but that this will limit my ability to vote and hold offices within the Annual Conference. I also affirm that I am not guaranteed an appointment within the Holston Annual Conference, but that I serve on an as needed basis until my credentials are fully recognized and I apply for membership in the Annual Conference. With this in mind…. I [__] do / [__] do not (mark one) currently seek to have my credentials recognized as equivalent with those of the United Methodist Church by the Board of Ordained Ministry. _____________________________________________ Signature

________________________________ Date

District -- Report of DCOM Action: Date this person met with the DCOM: ________________________________ Does the DCOM recommend this person for an Other Methodist (OE) Appointment? [__] Yes [__] No If No, then please list reasons: ___________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Rev. 2/20

Application 11

Application to come off of Voluntary Leave of Absence ሺVLOAሻ

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Rev. 4/20

Application 12

Application: Request for Less Than Full Time Service Name: ______________________________________________________________________ First Middle Last Address: ______________________________________________________________________ Street City State Zip Best Contact # (______)________‐__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ Clergy Status: [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________ I desire to serve: [__] 1/4 time [__] 1/2 time [__] 3/4 time

Reason for requesting Less Than Full Time Service: [__] 1.) Limited Itinerancy — ¶338.2.a).(1) You must submit a written letter, along with this application, stating that itineracy is limited due to temporary constraints which you are facing. Those constraints should be spelled out in the letter. Present the letter to the following persons: [__] The Bishop [__] The Chair of the Board of Ordained Ministry [__] 2.) Self‐Initiated — ¶338.2.a).(2) You must submit a written letter, along with this application, stating your request and the reasons for your desire to serve in a less than full time capacity. This request should be submitted at least 90 days prior to the annual conference session. The request should be submitted to: [__] The Bishop [__] The Chair of the Board of Ordained Ministry [__] 3.) Bishop‐Initiated — ¶338.2.a).(3) You will be notified via letter from the Bishop 90 days prior to the termination of your current appointment should the Bishop decide this is necessary for missional purposes. Request for Continuation of Less Than Full Time Services: [__] 1.) After consultation with my District Superintendent and having been previously granted a less than full time appointment, I request that I continue in this status for the upcoming Annual Conference year.

Rev. 2020‐10

Application 12

Acknowledgements: Initial here

I acknowledge that I have contacted the conference health insurance administrator and discussed any ramifications my request might have upon my health insurance.

Initial here

I acknowledge that I have contact the conference pensions administrator and/or Wespath and discussed any ramifications that my request might have upon my pensions.

Initial here

I understand that my request must receive the approval of both the cabinet and the Board of Ordained Ministry and that the full connection members of the clergy session must confirm my request by a 2/3 vote at its next scheduled session.

Initial here

I understand that if I continue to desire to serve in a less than full time capacity, that Holston Annual Conference requires me to request this on an annual basis with the request submitted by February 1st of each successive year.

Initial here

I understand that when I desire to come back into full time service that I must submit a written request to the Bishop and Cabinet at least six months prior to the annual conference session at which I desire to return to full time service. (December 1st will be an appropriate deadline.)

__________________________ _________________________ ___________________ 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: Request [__] was / [__] was not granted. Request Granted: _____ /_____ / 20______ Becomes Effective: _____ /_____ / 20_____ Month / Day / Year Month / Day / Year

Rev. 2020‐10

Application 13

Application: Request to Continue Previously Approved Voluntary Leave of Absence (VLOA) Status

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Updated: 2020‐10

Application 14

Application: Self-Initiated Discontinuance as a Local Pastor (FL) (PL) (¶320.1) Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

_____________________________________________________________________________________ District Superintendent ‐ Office Use: Month Day Year [__] Pastor surrendered License to Preach: _________ _________ __________ [__] Pastor surrendered LPLS Certificate: _________ _________ __________ [__] Circumstances that should be noted: ________________________________________________________________ ________________________________________________________________ DS Mailed surrendered materials to Conference Secretary: [__] License to Preach: _________ _________ __________ [__] LPLS Certificate: _________ _________ __________ _________ _________ __________ BOM follow‐up with Episcopal Office: [__] Episcopal Office was informed of the Discontinuance and the reasons for discontinuance.

Updated: 2020‐10

Application 15

Application: Self-Initiated Discontinuance as a Provisional Member (PE) (PD) (¶327.6)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

_____________________________________________________________________________________ District Superintendent ‐ Office Use: Month Day Year [__] Pastor surrendered License to Preach: _________ _________ __________ [__] Pastor surrendered Certificate of Provisional Membership: _________ _________ __________ [__] Membership was transferred after consultation with Pastor: _________ _________ __________ [__] Circumstances that should be noted: ______________________________________________________________________ DS Mailed surrendered materials to Conference Secretary: Month Day Year [__] Pastor surrendered License to Preach: _________ _________ __________ [__] Pastor surrendered Certificate of Provisional Membership: _________ _________ __________ Conference Secretary ‐ Office Use: Month Day Year BOM follow‐up with Episcopal Office: _________ _________ __________ [__] Episcopal Office was informed of the Discontinuance and the reasons for discontinuance. [__] Record of action filed with Annual Conference Secretary

Updated: 2020‐10

Application 16

Application: Sabbatical Leave (¶351)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

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: Start: _________ _________ __________ End: _________ _________ __________ 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 Concerns via ConferenceSecretary@holston.org [__] Current District Superintendent Office Use: Month Day Year Bishop approved request: _________ _________ __________ Date BOMEC/BOM approved request: _________ _________ __________

Updated: 2020‐10

Application 17

Application: Maternity / Paternity Leave (¶355)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Month Day

Year

[__] The anticipated date this leave will end is

_________ _________ __________

Month Day Year (This can be flexible, since there are always circumstances that might change the date. Our goal would be to give the full amount of time you request based upon the date you actually begin)

[__] I understand that I may take leave for up to one quarter (1/4) of a year (13 weeks), but that compensation will only be provided for the first eight (8) weeks of this leave. __________________________ _________________________ ___________________ Signature Printed Name Date _____________________________________________________________________________________ Please submit copies of this application to: [__] The Office of the Bishop [__] The Director of Clergy Concerns via ConferenceSecretary@holston.org [__] Current District Superintendent

Office Use: Episcopal Office approved request: BOMEC/BOM approved request:

Month Day Year _________ _________ __________ _________ _________ __________

Updated: 2020‐10

Application 18

Application: Request Retirement (¶357)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Best Contact # (______)________‐__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ Status: [__] Full Elder [__] Full Deacon [__] Associate Member [__] Local Pastor District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________ Having prayerfully considered my ministry and other factors in my life, I respectfully request that I be retired under the following provisions of ¶357: [__] Ad Interim (¶357.2.d) ‐ Between sessions of the annual conference [__] Mandatory (¶357.1) ‐ I will reach age 72 on or before July 1st prior to the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 20 Years of service (¶357.2a) – by the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 30 Years of service OR having reached age 62 (¶357.2b) – by the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 40 Years of service OR having reached age 65 (¶357.2c) – by the date of requested retirement and / or next scheduled annual conference. In addition to completing this Application, I also submit the attached letter stating my desire to retire. Effective date requested: ___________ ___________ __________ Month Day Year Submission deadlines:  To retire at the annual conference session, your application and letter should be received no later than 120 days prior to the annual conference session. February 1st is an appropriate date to meet this deadline requirement.  In the situation of Ad‐Interim Retirement, enough time must be allowed between the date of the Application and the Effective date of requested retirement as to allow the Benefits office to get necessary items in place for healthcare and pensions. Please allow a minimum of 30 days between the date you submit the Application and the Effective date requested. During that time, action will need to be taken by the Bishop / Cabinet and then the Board of Ordained Ministry Executive Committee (BOMEC) and then the Benefits Office. _________________________ ___________________ __________________________ 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 Concerns via ConferenceSecretary@holston.org [__] The Appointment Cabinet via current District Superintendent Office Use: Month Day Year For Ad‐Interim Retirements: Receipt of Request: _________ _________ __________ Bishop / Cabinet [__] did / [__] did not approved this request: _________ _________ __________ BOMEC [__] did / [__] did not approved this request: _________ _________ __________ Office of Clergy Services submit results to Benefits Office: _________ _________ __________ Updated: 2020‐10

Application 19

Application: Request for Honorable Location (¶358.3)

Name: _______________________________________________________________________________ First Middle Last Address: _______________________________________________________________________________ Street City State Zip Best Contact # (______)________‐_______________ Birthdate: __________ __________ _____________ [__] Cell [__] Home [__] Work Month Day Year Email: _______________________________________________________________________________ Clergy Status: [__] Full Elder [__] Full Deacon [__] Associate Member District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: _______________________________________________________________________________ After having prayerfully and thoughtfully considered my ministry, and the itinerant nature of that ministry, I feel that I can no longer participate in itinerant ministry. I, therefore, request that I be granted Honorable Location by the annual conference. Deadline for Application submission is 90 days prior to the annual conference. March 1st is an appropriate date to meet this deadline requirement. [__] I understand that the Board of Ordained Ministry (BOM) must first “examine my character” and find me in “good standing”. [__] I understand that the Clergy Session must also “examine my character” and find me in “good standing”. [__] I affirm that I intend to discontinue my service in itinerant ministry. [__] I understand that I will no longer hold membership in the annual conference and that my membership will be transferred to the ________________________________________________ United Methodist Church in the __________________________ District of the _____________________________ Annual Conference. [__] I further realize that prior to my membership being transferred, I must confer with my District Superintendent, the Pastor and PRC of the church to which my membership will be transferred. [__] I understand that I must surrender my Certificate of Conference Membership for deposit with the Secretary of the Annual Conference. [__] I understand that as a clergy member of the charge conference, I may only exercise ministerial functions with the written permission of the pastor in charge. [__] I understand that I am to supply an annual report to the charge conference stating my desire to continue on Honorable Location and that I must also send a copy of the annual report to the BOM Registrar’s Office. Failure to submit this annual report for two consecutive years may result in termination of orders upon recommendation of the BOM and the vote of the Clergy Session.

________________________________ _____ ____________________________________ _______________________ Signature Printed Name Date ________________________________________________________________________________________________________ Please submit copies of this application to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Conference Secretary via ConferenceSecretary@holston.org

Office Use: Month Day BOM passed on Character: ___________ ___________ BOM [__] recommends / [__] does not recommend transition assistance. BOMEC/BOM approved request: ___________ ___________ Honorable Location – Retired became effective: ___________ ___________

Year ____________ ____________ ____________

Updated: 2020‐10

Application 20

Application: Request for Honorable Location – Retired (¶358.3)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Office Use: Bishop / Cabinet approved request: BOMEC/BOM approved request: Honorable Location – Retired became effective:

Month Day ___________ ___________ ___________ ___________ ___________ ___________

Year ____________ ____________ ____________

Updated: 2020‐10

Application 21

Application: Request to Withdrawal

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Best Contact # (______)________‐__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ Clergy Status: [__] Full Elder [__] Full Deacon [__] Associate Member District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________ Having prayerfully and thoughtfully considered my relationship with the annual conference, I hereby request the following: Withdrawal to Unite with Another Denomination (¶360.1) I desire to withdraw from Holston Annual Conference: [__] and unite with the following denomination: ____________________________________ [__] I do not designate another denomination with which I will unite. [__] I understand that I must submit my Certificate of Conference Membership to the Secretary of the Annual Conference. [__] I understand that I must also submit a written letter to the persons listed below. Withdrawal from the Ordained Ministerial Office (¶360.2) [__] I desire to withdraw from the Ordained Ministerial Office and to withdraw from the annual conference. [__] I understand that I must also submit a written letter making this request and that I must also submit my Certificate of Ordination and Certificate of Conference Membership to my current District Superintendent who shall convey them to the Secretary of the Annual Conference. [__] I do not desire to transfer my membership to a local United Methodist Church. [__] I desire to transfer my membership to the _______________________________ United Methodist Church located in the _________________________________ District of the _____________________ Annual Conference after consultation with the pastor of this local church. Withdrawal Under Complaints or Charges (¶360.3) [__] Having been named in a complaint or charge, I hereby request to withdraw my membership from the Holston Annual Conference. [__] I understand that I must also submit a written letter making this request and that I must also submit my Certificate of Ordination and Certificate of Conference Membership to my current District Superintendent who shall convey them to the Secretary of the Annual Conference. [__] I do not desire to transfer my membership to a local United Methodist Church. [__] I desire to transfer my membership to the _______________________________ United Methodist Church located in the _________________________________ District of the _____________________ Annual Conference after consultation with the pastor of this local church. __________________________ _________________________ ___________________ 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 Concerns via ConferenceSecretary@holston.org [__] Cabinet via current District Superintendent Office Use: Bishop / Cabinet approved request: BOMEC/BOM approved request:

Month Day Year _________ _________ __________ _________ _________ __________

Updated: 2020‐10

Application 22

Application: Request to Continue Previously Approved Honorable Location (HL) (¶358)

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Updated: 2020‐10

Application 13

Application: Request to Continue Previously Approved Voluntary Leave of Absence (VLOA) Status

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Updated: 2020‐10

Board of Ordained Ministry Checklist 10

11 A36 CL10

Checklist to go on Voluntary Leave of Absence ሺVLOAሻ [__] Personal LOA [__] Family LOA [__] Transitional LOA

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Rev. 4/20

Board of Ordained Ministry Checklist 11

11 A36 CL11

Checklist to come off Voluntary Leave of Absence ሺVLOAሻ [__] Personal LOA [__] Family LOA [__] Transitional LOA

Name:

______________________________________________________________________

First

Middle

Last

Address:

______________________________________________________________________

Street

City

State

Zip

Rev. 4/20

SUMMARY REPORT Action Outline #1 Certified Candidacy DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org). Certified Candidacy Last First

Certified

Vote for Certified Candidacy Status Denied Delayed

Submit completed Report to:

clergyservices@holston.org

SUMMARY REPORT Action Outline #2 Renewal of Candidacy DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Renewal of Candidacy Last First

Submit completed Report to:

Vote for renewal of Candidacy for the upcoming conference year Continued Discontinued

clergyservices@holston.org

SUMMARY REPORT Action Outline #3 Local Pastor DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Local Pastor Last

First

Submit completed Report to:

Vote: License for Pastoral Ministry Approved Pending

clergyservices@holston.org

SUMMARY REPORT Action Outline #4 Local Pastor DCOM Registrar: District: On this form you will list all Local Pastors for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Local Pastor Last

First

Submit completed Report to:

Date of Vote for Continuance / Discontinuance Continuance Discontinuance

clergyservices@holston.org

SUMMARY REPORT Action Outline #5 Reinstatement DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Local Pastor Last

First

Submit completed Report to:

Vote: Reinstatement of License for Pastoral Ministry Approved Unapproved

clergyservices@holston.org

SUMMARY REPORT Action Outline #6 Provisional Membership Recommendation DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Provisional Membership Recommendation Last First

Orders Deacon / Elder

Submit completed Report to:

Vote Recommended Not Recommended

clergyservices@holston.org

SUMMARY REPORT Action Outline #7 Associate Membership Recommendation DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Associate Membership Recommendation Last First

Submit completed Report to:

Vote for: Election to Associate Membership Recommended Not Recommended

clergyservices@holston.org

SUMMARY REPORT Action Outline #8 Readmission to Conference Relationship DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Readmission to Conference Relationship Last First

Submit completed Report to:

Vote Recommended

Not Recommended

clergyservices@holston.org

SUMMARY REPORT Action Outline #09 Vote for Ordained Clergy from other denominations DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Clergy Last

First

Submit completed Report to:

Vote for Ordained Clergy from other denominations Date

clergyservices@holston.org

SUMMARY REPORT Action Outline #10 FL & PL that will be designated as Retired Local Pastors (RL) DCOM Registrar: District: On this form you will list all Person's for which a vote is taken and place the date of the vote in the appropriate column. Please file a copy of the Action Outline in the Person's DCOM file. This form is to be completed and sent to the Office of Clergy Services (ClergyServices@holston.org).

Local Pastor Name Last First

Submit completed Report to:

Approved Date

clergyservices@holston.org

Release 01

Candidate’s Permission to Release Psychological Assessment Information Candidate: Address: Best Contact # Email: District: DCOM meeting:

___________________________ ___________________________ _____________________ First Middle Last ___________________________________ ____________________ ______ ______________ Street City State Zip (________) ____________ ‐ _____________ [__] Cell [__] Home [__] Work _______________________________________________________________________________ [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR __________________________ Month

____________________ ___________ Day Year

Acknowledgement: ___________ Candidate Initial here

Counselor: Address: Best Contact # Email:

Having met with my District Committee on Ordained Ministry (DCOM) on the aforementioned date and having been required by the DCOM to seek counseling on matters raised in my psychological assessment, I hereby give permission for my psychological assessment to be shared with the following counselor for purposes of meeting the counseling requirement of the DCOM. ___________________________ ___________________________ _____________________ First Middle Last ___________________________________ ____________________ ______ ______________ Street City State Zip (________) ____________ ‐ _____________ [__] Cell [__] Home [__] Work _______________________________________________________________________________

Acknowledgement: ___________ Candidate Initial here

I also give permission to the above named counselor to share the outcome and / or substance of the counseling session(s) with the DCOM in order for the DCOM to make a more informed decision regarding my qualifications and desire to become a certified candidate for ministry. I understand that the counselor will be submitting a written report to the DCOM and that the DCOM may ask questions of the counselor in an attempt to further clarify the issue(s) for which the counseling was conducted.

__________________________________ __________________________________ ___________________ Candidate Signature Printed Name Date __________________________________ __________________________________ ___________________ Printed Name Date DCOM Chair Signature Copies of this Release are to be placed in the Candidate’s DCOM file and the Counselor’s file: [__] Chair, DCOM [__] Counselor

Revised: 2020‐09

Release 02

Candidate’s Permission to Release Files Candidate: ___________________________ ___________________________ _____________________ First Middle Last Address: ___________________________________ ____________________ ______ ______________ Street City State Zip Best Contact # (________) ____________ ‐ _____________ [__] Cell [__] Home [__] Work Email: _______________________________________________________________________________ District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Acknowledgement: By initialing below, I hereby give permission for the following documents in my file to be released electronically to the person(s) listed below. Documents to Release: (Initial to indicate permission) [____] Background Check [____] Credit Check [____] Psychological Report [____] Medical History Form Authorized to release documents to: ____________________________________________________________ First and Last Name Company: _____________________________________ Phone: (_______) ___________ ‐ _____________ [__] Cell [__] Home [__] Work Email: Documents to Release: (Initial to indicate permission) [____] Background Check [____] Credit Check [____] Psychological Report [____] Medical History Form Authorized to release documents to: ____________________________________________________________ First and Last Name Company: _____________________________________ Phone: (_______) ___________ ‐ _____________ [__] Cell [__] Home [__] Work Email: Documents to Release: (Initial to indicate permission) [____] Background Check [____] Credit Check [____] Psychological Report [____] Medical History Form Authorized to release documents to: ____________________________________________________________ First and Last Name Company: _____________________________________ Phone: (_______) ___________ ‐ _____________ [__] Cell [__] Home [__] Work Email: __________________________________ __________________________________ ___________________ Signature Printed Name Date Copies of this Release are to be placed in the Candidate’s DCOM file and the Conference Secretary’s file: [__] Chair, DCOM [__] Conference Secretary via conferencesecretary@holston.org

Updated: 2020‐10