2023 Northeastern Ministerial Standing Form Question Title * 1. Please enter your current contact information First Name * Last Name Home Address * Home Address 2 City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * OK Question Title * 2. Preferred method of contact: Email Voice Cell Phone Text Cell Phone Snail Mail OK Question Title * 3. I am a/an: Ordained Minister Commissioned Minister Retired Minister Please list the Date and Body of Commissioning/Ordination. If retired, please list the date of retirement. OK Question Title * 4. Please enter your current ministry setting information: If retired, you may skip to question 6. Ministry Setting Ministry Address Ministry Address 2 City/Town State/Province ZIP/Postal Code Website address Phone Number OK Question Title * 5. This is a: Full time position Part-time position OK Question Title * 6. Which geographical area of the Northeastern Region is your ministry setting located in? If you are retired, what geographical area do you currently reside in? Metro Western New England OK Question Title * 7. Congregation in which your membership is maintained: Congregation Name Address Address 2 City/Town State/Province ZIP/Postal Code Phone Number OK Question Title * 8. Describe your involvement in ministry in your local church during the past year: (If none, please write none) OK Question Title * 9. Describe your involvement in ministry in the Regional church during the past year:(If none, please write none) OK Question Title * 10. Describe your involvement in ministry in the General church during the past year: (If none, please write none) OK Question Title * 11. Describe your involvement in ministry in the Ecumenical church during the past year: (If none, please write none) OK Question Title * 12. Describe your involvement in teaching ministry in higher education, various forms of chaplaincies, pastoral counseling, or other activities that are recognized as ministry by the Christian Church (Disciples of Christ) . (If none, please write none) OK Question Title * 13. Have you financially contributed to a Disciples of Christ Congregation or DMF in 2022? Yes No Other (please specify) OK Question Title * 14. The practice of ministry involves participation in study, growth and renewal. Indicate experiences by which you have endeavored to strengthen your ministry in these ways during the past 5 Years: Seminary training/Certificate Program Continuing Eduration/ Seminary Events Ecumenical/interfaith trainings Regional Assembly General Assembly Camp/Conference Staff/Youth Events Ecumenical/Interfaith Organization Leadership Boundary Training Anti-Racism Training Clinical Pastoral Education (CPE) Review of Disciples History and Polity N/A Other (please specify) OK Question Title * 15. If you check marked above that you have attended trainings, please list the date of attendance, organization/person that provided it and place it occurred. Training 1: Training 2: Training 3: Training 4: Training 5: Training 6: Training 7: Training 8: OK Question Title * 16. Are you willing to be a faithful minister serving within and supportive of the Christian Church (Disciples of Christ)? Yes No OK Question Title * 17. Have you reviewed and agree to adhere to the “Ministerial Code of Ethics”? Yes No OK Question Title * 18. I have reviewed the Areas of Ministerial Practice and have concentrated my efforts of self-improvement in the past year on: OK Question Title * 19. Have you ever been charged with or convicted of a felony? Yes No If yes, please elaborate: OK Question Title * 20. Have you ever been charged with or convicted of any crime against persons? Yes No IF yes, please elaborate: OK Question Title * 21. Is there any reason that you should not be entrusted with the care, guidance or supervision of children or youth? Yes No If yes, please elaborate: OK Question Title * 22. Are there any ways the Regional Commission on Ministry or the Regional Minister and staff can be of assistance to you at this phase in your ministry? OK Question Title * 23. Have you encouraged anyone to consider ministry as a vocation recently? What is their name and contact information? OK Question Title * 24. This is a space for you to add any comments for further explanation or clarification on questions that you needed to expound on. OK DONE