EmailMe Form - CLERGY CONTACT INFORMATION FORM

Full Legal Name:

Prefix First Middle Last Suffix

Home Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Work Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone:

### - ### - ####

Email Address (Primary):

The email address which you want used for correspondence with the diocese.

Mobile Phone:

### - ### - ####

Alternate Email Address:

Work Phone:

### - ### - ####

Would you like to receive our e-publications such as the Coastline, Green Sheet, and Views from the Bishop's Chair?

Yes

No

Phone Contact Preference:

Home

Mobile

Work

Headshot:

Headshot for the database. The photo should be a minimum of 300x300 and no larger than 800 KB.

Birthdate:

MM / DD / YYYY

Social Security Number

Ordination Date - Diaconate:

MM / DD / YYYY

Ordination Date - Priest:

MM / DD / YYYY

Canonical Residence:

Seminary/Other Education:

Enter the seminary where you went as well as the graduation date.

Training Programs:

Safeguarding God's Children

Safeguarding God's People

Anti-Racism Training

Please check those training programs which you have completed.

Are you available for Supply work? If yes, please provide pertinent information such as travel radius, accommodation needs, etc.

Brief Biography

Please write a brief biography. This information may be used in our diocesan announcements as needed.

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