RETIRED MINISTERIAL STANDING FORM
Personal Information and Details
Email
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First Name
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Middle Name
Last Name
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Preferred Name
Address 1
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Address 2
City
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State
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Zip Code
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Cell Phone Number
Other Phone Number
Preferred Contact Method(s)
Cell Phone
Text Message
Email
Other Phone
District Currently Residing
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District Currently Serving (if applicable)
Date of Birth (e.g. 12/31/1901)
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Date of Retirement (e.g. 12/31/1901)
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Ethnicity
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AF - African American
As - Asian
E - European Descent (Caucasian)
Hi - Hispanic
Ha - Haitian
M - Middle Eastern
N - Native American/First Nations
O - Other
P - Pacific Islander
Marital Status
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Ordination/Commission Date
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Pastoral Code
RA - Retired Active
RI - Retired Inactive
Church Membership
If Not Connected To A Congregation - How can we help meeting your spiritual needs?
Ministerial Related Employment
Other Employment
Question to Affirm Standing
Since retirement with what opportunities are you engaged to promote well-being?
Since retirement what challenges are you facing that are concerning?
No longer central to congregational life, how do you now satisfy your needs for connection, affirmation, challenge, and purpose?
How would you rate your overall health (physical, mental, relational, spiritual)?
How can the Region assist you in your retirement?
If able, would you be willing to voluntarily serve on a regional board or committee?
Are you aware of the available Pension Fund resources?
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Yes
No
Above Information Can Be Shared With My Area Regional Elder?
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Yes
No
Ministerial Ethics
I have read and affirm "My Ministerial Code of Ethics"
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Yes
No
I fully understand all aspects of this standing form
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Yes
No
I have answered all questions truthfully and to the best of my abililty
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Yes
No
Digital Signature (Type Your Full Name)
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