Status Change Request Form

This form is to be completed by all who have a status change, whether it be retirement, a new call, an address change, etc. Thank you!

Today's Date

Last Name*

First Name*

Email Address*

Cell Phone #*

I am a...*

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I am requesting a Status Change of...*

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Effective Date of Status Change*

The Synod I am transferring to is...

If this doesn't apply to you, select N/A.

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The Synod I am transferring from is...

If this doesn't apply to you, select N/A.

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Marital Status

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Marriage Date if married

Spouse name, if married

Divorce Date if Divorced

Date of Birth*

Gender*

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Date of Ordination, Commissioning, or Consecration

Seminary you attended or are attending

Congregation called to or planning to attend...

If you are retiring, please let us know what congregation you plan to attend.

Congregation you are leaving from...

New Home Address

New Home City

New Home State

New Home Zip Code

What Social Media do you use?

Please check all that apply

Facebook

Instagram

Twitter

None

Other

If retiring, what will be your retirement date?

If retiring, please provide an overview of your retirement plan

If retiring, describe your hopes & dreams for retirement

If retiring, would you be willing to do transitional ministry?

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Are you available for Supply Preaching

This is for retirees, on leave from call, and SAM's,

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If so, please check which conference(s) you are willing to preach

Alamo

Bluebonnet

Capital North

Capital South

Cibolo Creek

Gulf Coast

Hill Country

Rio Grande

If you are requesting on leave from call, please include your rationale for going/remaining on-leave-from call. Include a statement of your commitment to be available for a letter of call and how your gifts and circumstances can contribute to the ministry and mission of this church.

What type of on leave from call do you request?

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On Leave from Call - What is the anticipated date that you will be available for call?

On Leave from Call - Please describe your ability and willingness to provide ministry services while on–leave from-call at the direction of the synodical bishop.

On Leave from Call - What is your plan for continuing education while on-leave-from-call?

If applying for Disability, what date would it start?

If applying for Disability status, please explain your reason for the request.

If applying for Disability status, have you contacted Portico?

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Photo of you (head shot only please)

Only if you are new to the Synod OR haven't given us one since previously

Drag and drop files here or

Send me a copy of my responses

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