EmailMe Form - 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. If serving UCC churches in Iowa (IA), Nebraska (NE) or South Dakota (SD), but have other denomination connections or in the process of becoming a UCC minister, we still appreciate the time to complete 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 *

Date Completed this Form *

MM / DD / YYYY

Birthdate

MM / DD / YYYY

Last Name *

Middle Name *

First Name *

Preferred First Name *

Race (Select one)

Marital Status

Preferred 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 / DD / YYYY

Child Name (still living at home)

Child Birthdate

MM / DD / YYYY

Child Name (still living at home)

Child Birthdate

MM / DD / YYYY

Child Name (still living at home)

Child Birthdate

MM / DD / YYYY

Child Name (still living at home)

Child Birthdate

MM / DD / YYYY

Household Address -Location/Mailing *

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

Preferred Email for Communication *

Secondary Email

Preferred Phone *

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

Home Phone

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

Mobile Phone

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

Business/Church Phone

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

SECTION: Ministerial Authorization and Standing

Church Membership (State/City/Name of church) *

Authorization *

Standing *

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 I am currently UCC Licensed - Renewal Date

MM / DD / YYYY

If I have current UCC MID Status - Granted Date

MM / DD / YYYY

If I am an ordained minister - Ordination Date

MM / DD / YYYY

Denomination of Ordination

If I currently hold OMPS - Granted Date

MM / DD / YYYY

If I currently hold Dual Standing - Granted Date

MM / DD / YYYY

Through POC I became UCC - Standing Date

MM / DD / YYYY

If I am a retired minister - Retirement Date

MM / DD / YYYY

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."

Recent YEAR I gave OCWM to my conference

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 / DD / YYYY

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

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

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

PLEASE READ - BEFORE YOU HIT THE SUBMIT BUTTON

The completed Information Review comes back to you as a list (inside the body of an email) confirming the submission. If you don't see it in your regular email inbox - please check your junk/spam email. We recommend retaining the email of the Information Review for your records.

To have a copy of the Information Review to look like this layout, please print before hitting the submit button. The 'print this submission' button is at the very top of the form.

** COME BACK AND HIT THE SUBMIT BUTTON TO COMPLETE SUBMISSION **

If you found that you made an error on your Information Review and decide to complete another form - PLEASE NOTE in the paragraph what change/addition you made. Thank you

SECTION: Ministerial Authorization and Standing

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."

SECTION: Ministerial Specialties - areas where I apply my skills

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.

SECTION: Pastoral Self-Care

** PLEASE READ - BEFORE YOU HIT THE SUBMIT BUTTON **

If you found that you made an error on your Information Review and decide to complete another form - PLEASE NOTE in the paragraph what change/addition you made. Thank you

PLEASE READ - BEFORE YOU HIT THE SUBMIT BUTTON