Northeastern Ministerial Standing Form 2020 Question Title * 1. Please enter your current contact information Name * Home Address * Home Address 2 City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * OK Question Title * 2. 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 * 3. Please enter your current ministry setting information: Ministry Setting Ministry Address * Ministry Address 2 City/Town * State/Province * ZIP/Postal Code * Website address * Phone Number * OK Question Title * 4. This is a: Full time position Part-time position OK Question Title * 5. Congregation in which your membership is maintained: Congregation Name Address * Address 2 City/Town * State/Province * ZIP/Postal Code * Phone Number * OK Question Title * 6. Describe your involvement in ministry in your local church during the past year: OK Question Title * 7. Describe your involvement in ministry in the Regional church during the past year: OK Question Title * 8. Describe your involvement in ministry in the General church during the past year: OK Question Title * 9. Describe your involvement in ministry in the Ecumenical church during the past year: OK Question Title * 10. 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) . OK Question Title * 11. 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 Other (please specify) OK Question Title * 12. 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 * 13. Are you willing to be a faithful minister serving within and supportive of the Christian Church (Disciples of Christ)? Yes No OK Question Title * 14. Have you reviewed and agree to adhere to the “Ministerial Code of Ethics”? Yes No OK Question Title * 15. Have you ever been charged with or convicted of a felony? Yes No If yes, please elaborate: OK Question Title * 16. Have you ever been charged with or convicted of any crime against persons? Yes No IF yes, please elaborate: OK Question Title * 17. 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 * 18. 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 * 19. 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