Section 1: Verify the Licensed/Commissioned Minister (you are completing this form for)

Name of Licensed/Commissioned Minister:
First      Last

Current Ministry this Licensed/Commissioned Minister Serves:
Name of Church, Institution, Agency

          Address

           Full Time Part Time           If Part Time, how many hours per week?

Section 2: General Questions

1. List the primary responsibilities of the Licensed/Commissioned Minister in your church or organization:
          

2. What highlights, milestones, new programs, important events, challenges, barriers, conflicts, etc. have
    taken place in your church or organization in the past twelve months and what role/responsibility did your
    Licensed/Commissioned Minister play in these events?:
          

3. What goals, dreams, expectations, etc. for your church or organization in the next twelve months?
          

4. What goals, dreams, expectations, etc. do you have for your Licensed/Commissioned Minister in the next
    twelve months?
          

5. In what area(s) of ministry do you believe your Licensed/Commissioned Minister's greatest strengths lie?
          

6. In what area(s) of ministry would you like to see your Licensed/Commissioned Minister strengthen their
    skills?
          

7. Does your church or organization have a "Pastoral Relations Committee"? Yes No

8. Does your church or organization have a "performance review" process in place for your
    Licensed/Commissioned Minister?
     Yes No

9. If you answered "Yes" to the previous question, how often does the review take place?
    

10. Who performs the review?

11. How might the Northwest Regional Christian Church be of further support to your congregation or
    organization?
          

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 the ongoing Licensed/Commissioned Ministerial Standing status of the named minister in the Northwest Regional Christian Church (Disciples of Christ) and with the General Office of the Christian Church (Disciples of Christ).

Please provide the name and position in the church or organization of the individual completing this report (or the name of the group, i.e. Church Board, Personnel Committee, etc.)

Name    

Position

Email    

Date