Request for Renewal of Standing For Ordained Ministers: 2022 Request for 2022 Standing Name(Required) First Middle Last Date of Birth(Required) MM slash DD slash YYYY Relationship Status(Required) Single Married Widowed Spouse's Name(Required) First Last Home Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Email(Required) Cell Phone(Required)Office PhoneHome PhoneI am an Ordained Minister Commissioned Minister I am a(Required) Active Ordained Minister Retired-Active Retired-Inactive Ordination Region(Required) I am a(n)(Required) Active Commissioned Minister Retired Commissioned Minister Present Ministerial Position(Required) Ministry Site Name(Required) Ministry City(Required) City Name of the Kansas congregation you are a member of(Required) Kansas Congregation City(Required) City Continuing Education With the adoption of the Theological Foundations & Policies & Criteria for the Ordering of Ministry, this is required of all ordained and commissioned ministers. List your continuing education events for 2021. Event(Required) Event Event Event Book/Journal(Required) Book/Journal Book/Journal Book/Journal I have attended an anti-racism workshop(Required) Yes No I have reviewed and will adhere to the "Ministerial Code of Ethics"(Required) Yes No I am willing to be a faithful minister serving within and supportive of the Christian Church (Disciples of Christ)(Required) Yes No Personal Disclosure Statement (If any question below is answered yes, please explain.)Have you ever been charged or convicted of a felony?(Required) Yes No Please explain your felony charges/conviction(Required) Have you ever been charged with or convicted of any crime against children or other persons?(Required) Yes No Please explain your charges/conviction of crimes against children or other persons(Required) Is there any other fact or circumstance in your background that should prevent you from being entrusted with the supervision, guidance and care of children or youth?(Required) Yes No Please explain the fact or circumstance that should prevent you from being entrusted with the supervision, guidance and care of children or youth(Required) Signature(Required) I understand that checking this box constitutes a legal signature. I certify the information provided is accurate. Sign your name below(Required)HiddenDate MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ
