Name *
Home Phone
Church, Agency or Business phone
Mobile Phone
Email Address *
Home Address, City, State, Zip *
Church, Agency or Business Address, City, State, Zip *
Charge Conference Membership * Addison: Good Samaritan Albany Alden Algonquin: Christ Alsip: Christ Antioch Apple River Argo Fay Arlington Heights: Church of the Incarnation Arlington Heights: First Ashton Aurora: Bethany of Fox Valley Aurora: First Nueva Vida Aurora: Wesley Barrington: Barrington Barrington: Salem Batavia Belvidere: First Belvidere: Iglesia Esperanza y Vida Bensenville: First Blaine Blue Island: La Gracia de Dios NFC Bolingbrook: Crossroads of Faith Bolingbrook: Friendship Brookfield: Compassion Brookville Buffalo Grove: Kingswood Burlington Burritt Capron Carol Stream: St. Andrew Cary Cedarville Chadwick: Hope Chana Channahon Cherry Valley Chicago: Adalberto Memorial Chicago: African Community Chicago: Amor de Dios Chicago: Bethany Riverview Pk-Jesus El Buen Pastor Chicago: Broadway Chicago: Chicago Lawn Chicago: Church of 3 Crosses Chicago: Clair Christian Chicago: East Side Chicago: Edison Park Chicago: El Redentor del Calvario/The Redeemer of Calvary Chicago: Emanuel Chicago: First (Temple) Chicago: First Vietnamese Chicago: Gorham Chicago: Grace of Logan Square Chicago: Granville Avenue Chicago: Greenstone Chicago: Hartzell Memorial Chicago: House of Praise Chicago: Humboldt Park Chicago: Hyde Park Korean Chicago: Indo Pak Chicago: Ingleside-Whitfield Chicago: Lincoln Chicago: Maple Park Chicago: Morgan Park Chicago: Olivet Chicago: Parish of the Holy Covenant Chicago: Ravenswood Fellowship Chicago: Recovery Community NFC Chicago: Renewed Hope Chicago: Resurrection Chicago: South Shore Chicago: Southlawn Chicago: St. Mark Chicago: St. Matthew Chicago: Trinity Chicago: Union Avenue Chicago: United Church of Hyde Park Chicago: United Church of Rogers Park Chicago: Urban Village Chicago: Wesley Chicago: West Ridge Coleta Creston Crete Crystal Lake: First Dakota Rock Grove Davis Junction Davis: Calvary DeKalb: First Des Plaines: First Des Plaines: Nuevo Amanecer Dixon: First Dixon: Grace Dolton: Faith Downers Grove: Faith Downers Grove: First Durand Earlville East Jordan Elgin: First Elgin: Journey of Hope Elizabeth: First Elk Grove: Prince of Peace Elmhurst: Christ Elmhurst: First Erie Esmond Evanston: Emmanuel Evanston: First Evanston: Hemenway Evanston: Sherman Evergreen Park: First Faith Connection of Wilton Center Flossmoor: South Suburban Korean Forreston: First UMC Fox River Grove: Community Franklin Park: First Franklin Park: Movement in the City Freeport: Faith Freeport: First Freeport: Harmony Freeport: Red Oak Galena Geneva Genoa: Faith German Valley Glen Ellyn: First Glencoe: North Shore Glenview: Glenview Grayslake: United Protestant Green Garden Hampshire: First Hampshire: Zion Hanover Harmon Harvard: First Harvey: Transformation Community Hazel Crest: Community Hebron Herbert: Davis Hickory Grove Hinckley: First Hinsdale Hunter Ingleside: Joyful Spirit Itasca: The Center Joliet: Cristo Es El Camino NFC Joliet: Grace Joliet: Hope Joliet: Ingalls Park Kaneville Kingston Kirkland: First LaGrange: First Lake Bluff: Grace Lake Villa LaMoille: Community Lanark Lansing: First LaSalle: Grace Leaf River Leland Lemont Lena Leon Libertyville Lockport: First Lombard: Faith Lombard: First Machesney Park: Evans Machesney Park: Harlem Malta Manhattan Maple Park: Grace Marengo Marseilles Maywood: Neighborhood McHenry: First McHenry: Mount Hope Melrose Park: Cosmopolitan Mendota: First Mendota: Zion Millbrook Milledgeville Millington Minooka Mokena Morris: First Morrison Mount Carroll Mount Morris: Disciples Mount Prospect: Sam Mool Korean Mount Prospect: Trinity Mundelein: Vision Church Naperville: Community Naperville: Grace Naperville: Hope Indian Naperville: Wesley Naperville: Wheatland Salem Naperville: Woori NFC New Lenox New Milford Northbrook: North Northfield Northbrook Norway Oak Lawn: First Oak Park: Euclid Avenue Oak Park: First Oak Park: St. John's Olympia Fields Orangeville Oregon Oregon: Lighthouse Orland Park: Faith Oswego: Good Shepherd Oswego: Wellspring NFC Ottawa: Epworth Ottawa: Evangelical Ottawa: First Palatine: First Palos Heights: Orland Park Korean Palos Heights: Palos Park Forest: Grace United Protestant Park Ridge: First Paw Paw Pearl City: First Pecatonica Peotone Plainfield Plattville Polo: Faith Poplar Grove Princeton: First Prophetstown Prospect Heights: Central Galilee Red Oak DeKalb Reynolds River Forest Riverside: Woodside Rochelle Rock Falls Rockford: Aldersgate Rockford: Beth Eden Rockford: Brooke Road Rockford: Centennial Multicultural Rockford: Christ Rockford: Christ the Carpenter Rockford: Court Street Rockford: Grace Rockford: Transform NFC Rockford: Victory NFC Rockton Roscoe Roselle Sandwich: United Savanna: First Scales Mound Schaumburg: Our Redeemer's Schaumburg: Our Saviour's Schaumburg: Salem Korean Seneca: First Serena Shannon: Bethel Sheridan Shirland Shorewood Skokie: Central Skokie: Jesus Love Korean South Elgin: Community St. Charles: Baker Memorial Sterling: First Sterling: Wesley Steward Stockton: Wesley Sugar Grove Sycamore Tampico Thomson Tinley Park Triumph Walnut Warren Waterman Wauconda: Federated Church Waukegan: First Waukegan: New Hope West Chicago: New Hope West Dundee: First Wheaton: Gary Wheeling: First Korean Wilmette: Trinity Wilmington Winfield: South Asian Winnebago Winthrop Harbor: North Prairie Wood Dale: The Center NFC Woodridge Woodstock: First Wyanet Yorkville: Trinity Zion: Memorial 1444
Charge Conference District * Prairie North Prairie Central Prairie South Lake North Lake South
Membership Status * Full Provisional
Please indicate your appointment category (para. 331.1) * Agency of setting beyond the local church United Methodist Church-Related agency, school or ecumenical agency Local Congregation, Charge or Cooperative Parish Endorsed by the GBHEM Endorsing Agency In service with the General Board of Global Ministries
Church, Agency or Business Name *
Title/Position *
Base Compensation per year
Utilities and other housing related allowances
Travel Allowance
Area of your certification, specialization or field of service
Are you on leave? If so, state the year of leave you have completed (first, second, etc.) (para. 353)
Read para. 328 and para. 329 of the Book of Discipline. Reflect and write about the ways in which you have lived out your call to the ministry of the deacon connecting the congregation with the needs of the world.
According to ¶ 419.7, the district superintendent shall receive a report of each clergy person on his or her program of continuing education and spiritual growth. According to ¶ 350, list the ways you have fulfilled
your plans for your continuing personal formation during the past year, including spiritual enrichment, service, mission, and continuing education opportunities.
Describe your plans for continuing formation in the year ahead.
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