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Non-parish Clergy Annual Report Form

Please return this annual report on or before December 31, 2009 to the Presbytery office. This report fulfills the Book of Order requirement, which provides that all minister members of the presbytery who are performing work not under the jurisdiction of the presbytery or a higher governing body of the church shall file an annual report with the presbytery (G-11.0502a).

Name *
Address *
City *
State *

Zip *
Phone (work)
Phone (home) *
E-mail Address: *
Phone (cell)
Date (mm/dd/yy) *
Has Your Information Changed Since Last Year? *
Yes
No
Church regularly attending:
Nature of involvement:
Are you a parish Associate:
Yes
No
Current presbytery involvement and responsibilities:
Current employer(s):
Address:
City:
State:

ZIP:
Phone:
Email:
Position(s) you hold:
Salary:
Housing:
The work is:
Full time
Part time
I am not employed at this time
I am seeking employment
Describe your responsibilities:
Name of organization providing evaluation and support for your work (include name of supervisor, address and phone):
Others to whom you are accountable:
Are you requesting a change in your ecclesiastical status?
Yes
No
If you answered yes to the previous question please give a reason:
Requested ecclesiastical status:
Honorably Retired
Active Member
Member-At-Large
Additional Comments
* Required