Section 1: Contact Information

Name:
First      Middle      Last

Vital Statistics:
Date of Birth      Ethnicity Please select one African American Asian European Descent Hatian Hispanic Middle Eastern Native American/First Nations Other Pacific Islander

Contact Info:
Home Address

Phone Numbers

Email Addresses

Section 2: Licensed/Commissioned Minister Detail Verification
I am classified as (check one):
           A Commissioned Church Worker
           Commissioned/Licensed Lay Minister
           Commissioned/Licensed Theological Student

I was first Commissioned/Licensed by the NW Regional Christian Church on:

I currently have standing with the NWRCC and wish to continue that status: Yes    No

Current Ministry Location:
Name of Church, Institution, Agency

          Address

          Date Ministry Began Full Time Part Time

Sexual Ethics/Boundary Training Criteria for the NW Region

Announced in October of 2009 and beginning in 2010 every ordained and licensed/commissioned minister is required to take six hours of training related to clergy sexual and ethical boundaries every three years. As we live into this new policy there is a grace period of two years: the training must be completed by the end of 2011.

If a licensed/commissioned or ordained minister with standing does not complete this training as required their licensing/standing will be removed, not for cause, until he/she completes the training.

Every minister receiving licensing/standing in the NWRCC will complete the training within two years and every three years thereafter. In-Care seminary students wishing to be ordained are encouraged to take the training during their last year of seminary.

If a minister transfers from another region and completed the boundary training within the calendar year in the other region, that training will fulfill this requirement. If not, they are required to complete the training within two years and every three years thereafter. An alternative to the NWRCC sponsored training course is for a minister to take the training offered by a member of Churches Uniting in Christ (CUIC).

Retired ministers who wish to function in any ministerial capacity are required to participate in this training.

When did you last attended a Sexual Ethics/Boundary Training event sponsored by the NWRCC Commission on Ministry (or any other institution's similar event)?

Indicate date and training attended:
(you may also be asked to provide proof of participation if you attended an event sponsored by a body other than the NWRCC):

Section 3: General Questions

1. Other Ministries in the past twelve months:
          

2. Names, locations and dates of continuing education, workshops, seminars or other job-related events
    attended, including degrees or certifications earned in the past twelve months:
          

3. Regional Church or General Church events, committees, commissions, boards, ecumenical service etc. you
    have participated in during the past twelve months:
          

4. In what area(s) of your ministry do you believe your greatest strengths lie?
          

5. In what area(s) of your ministry would you like to strengthen your skills?
          

6. Share highlights, milestones, new programs, important events, challenges, barriers, conflicts, etc. that have
    taken place at your place of ministry in the past twelve months:
          

7. Share goals, dreams, expectations, etc. for yourself in the next twelve months:
          

8. How can the Northwest Regional Christian Church be of further support in your ministry?
          

Signature
By typing your name and date below and pressing the "Submit" button, you acknowledge that you are accountable for the information submitted and that the answers to the questions above will be used to determine your ongoing Licensed/Commissioned Ministerial Standing status in the Northwest Regional Christian Church (Disciples of Christ) and with the General Office of the Christian Church (Disciples of Christ).

Name    Date