Board of Lay Ministry: Form 01 For use only when LM is appointed to a local church as a supply pastor
Certified Lay Minister (LM) Supervisory Agreement with the District Superintendent Name:
______________________________________________________________________ First Middle Last
Address:
______________________________________________________________________ Street City State Zip
Best Contact # __________________________ Birthdate: [__] Cell [__] Home [__] Work Email:
_________ _________ __________ Month Day Year
______________________________________________________________________
As a Certified Lay Minister (LM), I have been asked to serve the following: District
AP
CM
HI
Charge Church 1
MV
NR
SS
SM
TV
TR
Church 2
Street
Street
City
City
State Zip
State Zip
Worship Time Frequency Weekly Monthly Church 3
Bi‐weekly
Worship Time Frequency
Street
City
City
State Zip
State Zip
FORM 17‐LM Supervisory Agreement
Bi‐weekly
Weekly Monthly
Bi‐weekly
Church 4
Street
Worship Time Frequency Weekly Monthly
Weekly Monthly
Bi‐weekly
Worship Time Frequency
Revised: 2020‐05‐07