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2021 INFORMATION REVIEW-Iowa-Nebraska-South Dakota
Information Reviews are requested each year for those with UCC ministerial standing as part of requirement for good standing. The 2021 Information Review is due by Feb 15, 2021.
If you are serving UCC churches in Iowa (IA), Nebraska (NE) or South Dakota (SD), but are authorized for ministry by another denomination or are in the process of becoming a UCC minister, we appreciate you also completing this form. At the end, the submit button forwards this information review to the conference office, the correct COM chair, and to the preferred email address used on this form. Thank you.
Please select conference/association
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Iowa - Central
Iowa - Eastern Iowa
Iowa - Northeast
Iowa - Northwestern
Iowa - Southeastern
Iowa - Southwestern
Nebraska - Heartland
Nebraska - Living Waters
Nebraska - Prairie
South Dakota - Black Hills
South Dakota - Dakota
South Dakota - Oahe
South Dakota - Prairie Lakes
South Dakota - Two Rivers
Date Completed this Form
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MM
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Birthdate
MM
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DD
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YYYY
Last Name
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Middle Name
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First Name
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Preferred First Name
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Race (Select one)
White/Euro-American
African American
Asian/Pacific Islander
Hispanic/Latino(a)
Native American
Bi-Racial/Multi-Racial
Other
Marital Status
Single
Married
Partnered
Widowed
Divorced
Your Pronouns
He/Him/His
She/Her/Hers
They/Them/Theirs
Other pronoun choice
Gender
Male
Female
Transgender/Gender Expansive
Spouse/Partner Name
Spouse/Partner Birthdate
MM
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DD
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YYYY
Child Name (still living at home)
Child Birthdate
MM
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DD
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YYYY
Child Name (still living at home)
Child Birthdate
MM
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DD
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YYYY
Child Name (still living at home)
Child Birthdate
MM
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DD
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YYYY
Child Name (still living at home)
Child Birthdate
MM
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DD
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YYYY
Household Address -Location/Mailing
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Preferred Email for Communication
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Secondary Email
Preferred Phone
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Home Phone
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Mobile Phone
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Business/Church Phone
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SECTION: Ministerial Authorization and Standing
Church Membership (State/City/Name of church)
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UCC Ministerial Standing
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UCC Ordained Ministerial Standing
UCC Ordained Ministerial Standing - Leave of Absence
UCC Ordained Ministerial Standing - Exempt Standing
Ordained Ministerial Partner Standing (OMPS) (only if ordained DOC)
Dual Standing
UCC Lay Ministerial Standing
UCC Commissioned Minister
UCC Licensed Minister
None of the above
UCC Ecclesial Status
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Member in Discernment
Seeking Ordained Ministerial Partner Standing
Seeking Privilege of Call
None of the above
Check IF any of these applies to you
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Layperson acting as pastor in UCC congregation
Layperson (MID candidate)
Ordination is held currently in another denomination
None of the above
Other UCC conference/association where currently hold standing; or Non UCC denomination where currently hold standing; or denomination where affiliated but have no ministerial standing.
If you are currently UCC licensed, what date does your license next require renewal?
MM
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If you are an ordained minister, what date were you ordained?
MM
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Denomination of Ordination
If you currently have Ordained Ministerial Partner Standing, what date was it granted by the Committee?
MM
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If you currently have Dual Standing, what date was it granted by the Committee?
MM
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If you were granted UCC Ordained Ministerial Standing through Privilege of Call, what date was it granted by the Committee?
MM
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Last Year of Boundary Training
Last Year of Periodic Vocational Support (PVS)
Last Year of Multicultural Training
I have a signed 3 way or 4 way covenant
Yes
No
Brief notes on continuing education in last 2 years
SECTION: "Giving to Our Church's Wider Mission (OCWM) is a one expression of our covenantal connection with the wider UCC and is expected of all our churches and ministers."
Most recent YEAR I gave OCWM to my conference
Most recent YEAR I gave OCWM through my church
Most recent YEAR the church where I pastor gave to OCWM
I would like conference assistance to visit with my church about OCWM giving
Yes
SECTION: Ministerial Specialties - areas where I apply my skills
I'm available for (check all that apply):
Pulpit Supply (Complete/submit your background check request at ucctcm.org/safechurch)
Weddings (for both LGBTQ+ and straight couples)
I'm interested in serving (check all that apply)
Transitional/Interim Ministry
Certified Intentional Interim Ministry
UCC Church or Churches I am Serving (State/City/Name of Church)
Start Date of Position
MM
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Hours per week
Full-time (40-50 hrs)
Part-time 3/4 (30-37.5 hrs)
Part-time 1/2 (20-25 hrs)
Part-time 1/4 (10-12.5 hrs)
Position title
Pastor
Co-Pastor
Pastor (senior)
Pastor (associate)
Pastor (interim)
Pastor (supply)
Pastor (education/youth)
Chaplain
Spiritual Director
Professional Coach
Other place of work (in addition to or instead of UCC church or churches listed)
Other place of work (address with city/state and position title)
SECTION: Information about the UCC church where I serve as a Pastor or that I am a member of. If serving more than one IA, NE or SD UCC church, I have noted the church connection/position/leader name/leader email in the additional space below.
UCC Church Moderator Name
Church Moderator email
UCC Church PPR (pastor parish relations) Chair Name
Church PPR chair email
UCC Church Admin/Office Name
Church Admin/Office email
UCC Church Treasurer Name
Church Treasurer email
Your UCC Church's Email Address
Additional UCC Church/Churches I am serving- Leader Name/Position/Emails
SECTION: Pastoral Self-Care
I have support for my ministry from a (check all that apply)
Spiritual director
Coach
Therapist
Collegial community of practice
I receive reimbursement from my calling body for these expenses
Yes, for all
Yes, for some
No
In a profession that cares for others, pastors are encouraged to have an ongoing relationship to a spiritual director, therapist, and/or professional coach as well as participate in a community of practice. Please check all that apply:
I currently utilize a spiritual director, therapist, and/or professional coach.
I currently participate in a clergy Community of Practice.
I would like more information about available spiritual directors, therapists, and/or professional coaches.
I would like more information about joining a clergy Community of Practice.
I would like assistance in renegotiating my call contract to include the cost of working with a spiritual director, therapist, and/or professional coach as a reimbursable professional expenses and appropriate use of professional time.
I would like assistance in renegotiating my call contract to include the cost of joining a clergy Community of Practice as a reimbursable professional expenses and appropriate use of professional time.
I do not have interest at this time in working with spiritual director, therapist, and/or professional coach or participating in a clergy Community of Practice.
Other (use space below to describe)
Additional Comments or Concerns not mentioned on this form
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