Candidates for Provisional Elder File checklist for those applying to be Provisional Elders

Transcription

1 Candidates for Provisional Elder It is your responsibility to see that each of these items is in your file at the Office of the Director of Ministerial Services by 3pm Central Time, November 3, This includes forms and evaluations completed by others on your behalf, as well as DVDs of your sermons. There are no exceptions to this rule, as per the policy of the Board of Ordained Ministry. You are welcome to send in items as you complete them. A file audit will be done when requested. File checklist for those applying to be Provisional Elders 1. Application for Ministerial Relationship 2. Background Check (cannot be more than five years old) 3. Bible Study Manuscript 4. Biographical Information Form 5. College Transcript 6. Consent Form 7. DCOM Recommendation 8. Doctrinal Questions 9. District Superintendent Request Form 10. Lay Member Recommendation (to be sent directly to the Office of Ministerial Services) 11. Lay Member Recommendation (to be sent directly to the Office of Ministerial Services) 12. Lay Member Recommendation (to be sent directly to the Office of Ministerial Services) 13. Medical Form (cannot be more than five years old) 14. Ministerial Effectiveness and Leadership Report 15. Ministerial Recommendation (to be sent directly to the Office of Ministerial Services) 16. Ministerial Recommendation (to be sent directly to the Office of Ministerial Services) 17. Ministerial Recommendation (to be sent directly to the Office of Ministerial Services) 18. PPRC/SPRC Recommendation 19. Psychological Assessment (cannot be more than five years old) 20. Self Evaluation and Report of Progress in Ministry 21. Seminary Transcript 22. Sermon Evaluation 23. Sermon Evaluation 24. Sermon Evaluation 25. Sermon Bulletin (1 original) 26. Sermon DVD 27. Sermon Manuscript 28. UMC Candidate s Disclosure Form Items needed on file before you begin the Residency Program, but are not required at this time: 29. CPE certificate of completion 30. CPE evaluation 31. Sexual Ethics Beginning Seminar Certificate (within last 4 years) 32. Completed Seminary transcript 33. Completed AWF educational requirements Items others are responsible for submitting, not you: 1. Cabinet Composite Letter (comes from the Cabinet)

2 To: From: Subject: All Candidates for Provisional Elder Rev. Sara Shaver, Chair of the Order of Elders Materials needed by the Board of Ordained Ministry Greetings to all! It is a joy to celebrate your following God s calling into ministry! The Board of Ordained Ministry of the Alabama West Florida Conference is excited to work with you to determine how you can best serve God through the United Methodist Church. Do your best work on this material and be sure to follow the instructions in this letter and throughout this packet. Failure to follow the directions given can be grounds for delaying your commissioning. This application packet is to be completed and returned to Rev. June Jernigan by 3pm Central Time, November 3, 2014 by those who seek to be commissioned as Provisional Elders at the 2015 Annual Conference. Remember, you are not required to complete this packet just because you are eligible to apply, if you do not feel you can do your best work. You simply may apply the following year to be interviewed by the Board of Ordained Ministry. You will receive information later with a specific day and time to arrive at Blue Lake for your interview with the Board of Ordained Ministry. Below are some guidelines for submission of your information, suggestions for making this process smooth for you, and answers to some frequently asked questions. Put your name and the date at the top of every page that you turn in. You are responsible for the cost of your medical exam. EKG s, etc. are not required unless your physician feels your condition warrants such tests for a clean bill of health. one copy of your sermon manuscript (not transcript) to Rev. June Jernigan at june@awfumc.org. Additionally, mail one copy of a DVD of your sermon being preached to Rev. Jernigan at the above address. Sermon guidelines are included in this packet. Follow them carefully. Print three copies of the sermon evaluation form (included in packet) and give to three lay persons to do the evaluation. Three evaluations must be received from laypersons. You are responsible for insuring our timely receipt of these evaluations. one copy of your Bible study to Rev. Jernigan. Guidelines are included in this packet. Follow them carefully. The doctrinal questions you will answer are from the 2012 Book of Discipline, Paragraph 324.9, which are included in this packet. your responses to Rev. Jernigan. one copy of your Ministerial Effectiveness and Leadership information. Guidelines are included in this packet. Follow them carefully. If you are not presently serving or working at a church, have the PPR/SPR evaluation filled out by your home church PPR/SPR committee, or return it to Rev. Jernigan with a detailed explanation. The ministerial evaluations must be completed by members in full connection in the Alabama West Florida Conference. This includes retired clergy. (Three recommendations are required.)

3 It is your responsibility to see that we have a copy of your psychological report, medical report and background check. All of these must be within the past five years. Background check authorization can be found on our website at: (Background check authorization) Recommendations and forms which others complete on your behalf may take a while. Have them filled out ASAP, for your peace of mind. If they are not turned in by the deadline, your application packet will be incomplete, and you will not be able to appear before the BOM to be considered for commissioning this year. It is your responsibility to see that Rev. Jernigan receives all forms and evaluations by 3pm Central Time, November 3, This includes making sure that the papers being filled out for you by others have been mailed directly to her by this date. Please note the following: Completing these written assignments and appearing for an interview does not guarantee that you will be commissioned as a Provisional Elder. This privilege is granted only by a 2/3 majority vote of the Board and the clergy session of Annual Conference. Do not hesitate to contact me or Rev. Jernigan with any questions. May God continue to bless you in your ministry!

4 PROVISIONAL MEMBERSHIP AND ORDINATION POLICIES 1. Authority: of the 2012 Book of Discipline 2. A person coming from another denomination or from another conference may be considered for membership provided they meet the requirements of All commissioned ministers shall serve within the scope of practice of the order for which they are preparing (i.e., deacon or elder) for the entire provisional period [ 326]. 5. CPE (Clinical Pastoral Education) is required of all persons seeking ordination as deacons and elders. CPE requirements must be completed prior to the beginning of the two -year residency. 7. Students who have completed ½ of the basic graduate theological studies as listed in par of the 2012 Book of Discipline may apply for commissioning. These basic graduate theological studies must includes courses in Old Testament; New Testament; theology; church history; mission of the church in the world; evangelism; worship/liturgy; and United Methodist doctrine, polity and history. However, all educational requirements (both Discipline and conference) must be completed prior to the beginning of the two -year residency. 8. Additional educational conference requirements include: CONFERENCE EDUCATIONAL REQUIREMENTS FOR ELDER'S ORDERS All candidates for Elder's Orders in the Alabama-West Florida annual conference must take the following courses in addition to the disciplinary requirements [ 324, 2008 Book of Discipline]: Please note: you must be a Certified Candidate for a minimum of one year before applying for commissioning as provisional Elder.

5 APPLICATION FOR MINISTERIAL RELATIONSHIP TO THE ANNUAL CONFERENCE FOR PROVISIONAL ELDER ALABAMA-WEST FLORIDA CONFERENCE Today s Date: District: Social Security Number: Address: City, State, and Zip: Cell Phone: Date and Place of Birth: Name: (FULL NAME. NO INITIALS!) Marital Status: Single: Married: Widowed: Divorced: Number of children: Age of each child: ; ; ; Certificate of Candidacy: Date of Issue: District: EDUCATIONAL QUALIFICATIONS: High School: Place Date College: Name Date attended Degree or credit hours Seminary ( 315.4) Name Date attended Degree or credit hours Full-Time Local Pastor: Associate Member: Previous Ordination: Number of Years Number of Years Number of Years Dates Dates Dates

6 Biographical Information Form Name: Date: Address and Zip Code: Home Phone ( ) School or Office Phone ( ) Date of Birth: Sex: M F Ethnic Origin: Asian Black /African American Hispanic Native American Pacific Islander White Local Church: Conference: City: District: Briefly describe your involvement in your local church, such as your leadership positions, groups you enjoy, church activities, etc. Describe your church involvement in activities beyond your local church, such as district or annual conference work, church camps, workshops, outreach, etc. Your Educational Background: Dates Attended Degree or Credit Hrs. High school College Graduate School Theological Seminary Course of Study for Ordained Ministry Advanced Course of Study: Yr.1 Yr.2 Yr.3 Yr.4 Yr.5 Semester Hours Credit Marital Status: Single, never married Married, in first marriage Married, in second or more Widowed Separated Divorced If married, spouse s name Spouse s birth date Date of Marriage Spouse s occupation

7 (page 2, Biographical form) Your children, if any: Name of child Date of Birth Gender Education Dependents in addition to your spouse and children: Describe your community involvement and volunteer work, such as participation in community organizations, social clubs, service agencies, and other non-church-related volunteer service: Your childhood family and other significant relatives: Name Relation Age Gender Education Marital Status Occupation Father Mother Your work experience, such as current employment, previous employment, and military experience, if any. Have you served as a local pastor, diaconal minister, deacon or elder in the United Methodist Church? Conference? Conference Relationship (Indicate Date) Change in Conference Relationship (Indicate Date) Consecrated Diaconal Minister Discontinuance License as a Local Pastor Leave of Absence Associate Member Disability Leave Provisional Member Location Deacon in Full Connection Retirement Elder in Full Connection Withdrawal Have you had a change in clergy relationship with a Termination by action of the conference of the United Methodist annual conference Church? Conference?

8 Consent Form I hereby give my consent for the Alabama-West Florida Conference Board of Ordained Ministry to use the following information for the use of interviewing and considering me for Ordained Ministry: official transcripts from colleges and seminaries, evaluation of Supervised Ministries Projects, CPE evaluations, background check information, evaluation of psychological tests, biographical information, academic records, recommendations from laity, clergy, Pastor-Parish Relations Committee, District Committee on Ministry, and the District Superintendent, and any other material submitted by the applicant. I understand that my file must be complete with all items turned in by the deadline in order for me to be considered for Provisional Membership in I understand that if I am admitted into Provisional Membership, I must participate fully in the Residency Program of the Alabama West Florida Conference, or be approved by the BOM to participate in the Residency Program of the Conference to which I am appointed. Failure to participate will render me ineligible for Full Membership. Name: Date:

9 DISTRICT COMMITTEE ON ORDAINED MINISTRY RECOMMENDATION FOR PROVISIONAL ELDER ALABAMA-WEST FLORIDA CONFERENCE The Committee on Ordained Ministry of the District of the Alabama- West Florida Conference, in accordance with of the 2012 Book of Discipline of The United Methodist Church recommends: Name for Election and Commissioning to Provisional Elder in the Alabama-West Florida Conference. Chairperson, District Committee Registrar, District Committee Date: Please send this completed form to: Rev. June Jernigan

10 Guidelines for Bible Study for Provisional Elder Choose one: Judges, Job, Mark, James If you have submitted a study on one of these books previously, you must choose one of the others. You are to prepare a written six-to-eight week Bible study. The purpose of this requirement is to place emphasis upon your need to be effective in teaching the Bible to persons of all ages. The committee will be evaluating your level of understanding of the prescribed biblical text, your desire to open the Word of God to God s people through Bible study, and your comfort/anxiety level in leading Bible study classes. You do not have to teach this study prior to submission. Please follow these guidelines in fulfilling this requirement: 1. The Bible study should be designed to include six to eight sessions and COVER THE ENTIRE BOOK from the first chapter to the last. Each session should be no shorter than one hour and no longer than two hours. You may use any number of sources and must include a bibliography of those sources. 2. The Bible should serve as the primary source, and the study should be your work. 3. You are not to copy the study from another text, though you may follow the outline of another text or curriculum. It is expected that the study will reflect theological understandings that are consistent with our Wesleyan heritage. The committee is looking for evidence of the ways you worked with the biblical text. Work with questions that deal with the biblical text as opposed to those that might deal with a commentator s ideas. 4. Describe the setting of the study and the response of participants to the study (if it has been taught). Describe the teaching method that you will use (lecture, discussion, small groups, etc). The teaching method should be selected based on the objectives for the study, your gifts as the leader, and the direction of the text. 5. You are to use an outline form of no more than one to two pages per session. These outlines should cover the entire book, from the first chapter to the last. This outline should include the objectives for each session (no more than three for each session), primary and secondary topics, resources that are to be used, questions that are to be asked, etc. Objectives for each session should be written clearly in correct form, such as: At the end of this session, the class will know.... Or At the end of this session, the class will be able to. 6. For one of the sessions, be as detailed as possible. In manuscript form, give time frames for each activity, major and minor points to be discussed and very detailed information concerning the class, the environment, and materials used. This one session should be as informative for the committee as possible. Use as many pages for this session as needed to give the details required. 7. As with any professional work, careful attention should be given to proper grammar and spelling. Bring a copy of the Bible study with you to the interview. Note: If your work does not include all of the items listed, the requirements for this area will not have been met. this to Rev. Jernigan at june@awfumc.org.

11 Doctrinal Questions According to par of the 2012 Book of Discipline, Each candidate shall respond to a written and oral doctrinal examination administered by the conference Board of Ordained Ministry. Write a response to all of the following questions. Your response should reflect your personal belief and understanding of United Methodist doctrine and should be as lengthy as needed to reflect your understanding. Give special attention to appropriate grammar, spelling, and source citation. It would be wise for applicants to refer to the next document Doctrine and Theology Committee and read the tips from the committee. your responses to the questions below to June@awfumc.org. NOTE: THIS FORM IS NOT IN A FILLABLE FORMAT. MUST BE PRINTED OFF AND TURNED IN. a) Describe your personal experience of God and the understanding of God you derive from biblical, theological, and historical sources. b) What is your understanding of evil as it exists in the world? c) What is your understanding of humanity, and the human need for divine grace? d) How do you interpret the statement Jesus Christ is Lord? e) What is your conception of the activity of the Holy Spirit in personal faith, in the community of believers, and in responsible living in the world? f) What is your understanding of the kingdom of God; the Resurrection; eternal life? g) How do you intend to affirm, teach and apply Part III of the Discipline (Doctrinal Standards and Our Theological Task) in your work in the ministry to which you have been called? h) The United Methodist Church holds that the living core of the Christian faith was revealed in Scripture, illumined by tradition, vivified in personal experience, and confirmed by reason. What is your understanding of this theological position of the Church? i) Describe the nature and mission of the Church. What are its primary tasks today? j) Discuss your understanding of the primary characteristics of United Methodist polity. k) How do you perceive yourself, your gifts, your motives, your role, and your commitment as a probationary member and commissioned minister in The United Methodist Church? l) Describe your understanding of diakonia, the servant ministry of the church, and the servant ministry of the provisional member. m) What is the meaning of ordination in the context of the general ministry of the Church? n) Describe your understanding of an inclusive church and ministry.

12 o) You have agreed as a candidate for the sake of the mission of Jesus Christ in the world and the most effective witness of the gospel, and in consideration of their influence as ministers, to make a complete dedication of yourself to the highest ideals of the Christian life, and to this end agree to exercise responsible self-control by personal habits conducive to bodily health, mental and emotional maturity, integrity in all personal relationships, fidelity in marriage and celibacy in singleness, social responsibility, and growth in grace and the knowledge and love of God. What is your understanding of this agreement? p) Explain the role and significance of the sacraments in the ministry to which you have been called.

13 Doctrine and Theology Committee THE SUCCESSFUL CANDIDATE 1. The successful candidate generally submits a well constructed, carefully proofread paper of 30 to 40 pages double spaced. The Disciplinary questions should be included in the paper with each response given. These questions should be single spaced using 12 point times new roman. 2. Computer spell checking is generally not sufficient for the type of work expected of those with college and graduate degrees. While spelling and grammar are not a part of the Doctrinal Examination, they are important tools of the ministry of Associate Members. 3. There are not any yes or no questions among those asked. The purpose of the questions is to give the candidate an opportunity to demonstrate theological reflection and understanding of the doctrinal issues under consideration and to communicate these reflections to a larger group. 4. Choose a writing style guide and use it when writing this scholarly paper. Some of the common style guides are The Chicago Manual of Style, the MLA Style Manual, and Turabian s Manual for Writers. 5. The interview will give the candidate an opportunity to respond to points in the paper raised by members of the Doctrine Committee as well as to address items not specifically covered by the paper. STATEMENT OF PURPOSE: The purpose of the Doctrine and Theology Committee of the Board of Ordained Ministry of the Alabama-West Florida Conference is to examine future ministers of the United Methodist Church as to each candidate's understanding of the doctrines that distinguish us as Christians and United Methodists. We hold to the distinctions made by John Wesley in his sermon Catholic Spirit, that there are essential doctrines and non-essential doctrines among all believers. At the same time, we realize that there are certain doctrines that distinguish Christians from all other religions and United Methodists from all other denominations. In addition, it is essential that the candidate for ordination understand the issues of polity and discipline that are an integral part of the United Methodist Church. It is to address these issues that the Doctrine and Theology Committee functions as a part of the Board of Ordained Ministry. The guidelines for questions to be asked of candidates seeking admission as provisional members are found in 324 of the 2012 Discipline. For those seeking full connection and ordination as a Deacon the questions used as guidelines are provided in 330 of the 2012 Discipline. For those seeking full connection and ordination as Elder the questions used as guidelines are provided in 335 of the 2012 Discipline. The Committee does not seek to create points of contention with a candidate, but rather to be sure that the candidate fully understands the essential doctrines of Christianity and the United Methodist Church. Should the candidate show a lack of knowledge of key doctrinal issues, or have issues with United Methodist doctrine or polity, it is the responsibility of the committee to draw attention to these issues and bring clarity to the candidate. If necessary, the candidate may be asked to do additional study in the area of disagreement or confusion. It is the responsibility of the committee to report their findings to the Board, and make recommendations as to their approval or disapproval of a candidate.

14 The following areas should be addressed either by the questions from the Discipline or in the interviews with the Committee: GENERAL DOCTRINES OF THE CHURCH UNIVERSAL 1. Trinitarian Doctrines 2. Doctrines Relating to Salvation A. By Faith Alone B. Place of Works 3. Doctrines Relating to the Church A. Evangelism B. Missions C. Kingdom of God GENERAL DOCTRINES OF THE UNITED METHODIST CHURCH 1. Doctrines Relating to Justification A. Repentance B. Assurance 2. Doctrines Relating to Sanctification A. Work of Holy Spirit B. Life of Inward and Outward Holiness 3. Doctrines Relating to Polity and Discipline A. United Methodist Structure B. Itinerant System - Appointments 1). Role of Cabinet 2). Willingness to go where appointed C. Ministry as Vocation 4. Doctrines Relating to the Sacraments A. Baptism - understanding of United Methodist position on infant baptism B. Communion 5. Position of the United Methodist Church with Regard to Social Principles A. Importance of Moral Integrity in the Ministry B. Importance of Family C. Lifestyle Issues

15 D. Social Responsibility 6. Positions Relating to the Four Foundations of Spiritual Truth A. Scripture - Primacy of B. Reason C. Tradition D. Experience

16 District Superintendent Request NOTE: THIS FORM IS NOT IN A FILLABLE FORMAT. MUST BE PRINTED OFF AND TURNED IN. Print and obtain both necessary signatures for this form and send to Rev. Jernigan at this address: Rev. June Jernigan june@awfumc.org I,, request that the Cabinet of the Alabama West Florida (Please Print) Conference recommend me for (please circle) Associate Membership; Provisional Deacon; Full Deacon; Provisional Elder; Full Elder in the Alabama West Florida Conference of the United Methodist Church. Applicant s Name Date Received by District Superintendent Date Requested Signature of District Superintendent

17 Candidate: Please forward this form to your three Lay Member Recommendations. Click HERE for the link. Lay Member Recommendation is applying for admission as a Provisional Elder in the Alabama-West Florida Conference and has named you as a reference. The Board of Ordained Ministry asks each applicant to secure the recommendation of three (3) laypersons. Will you kindly aid the church in judging the applicant s fitness for the Christian ministry by supplying the information requested below? In addition to checking those items about which you have information, give us a summary paragraph stating your frank opinion as to whether or not the applicant has the qualifications to make a good minister and should be encouraged to enter that calling. 1. How long and under what circumstances have you known the applicant? 2. Give any information you can regarding home conditions and family background that would bear upon her/his qualifications for the ministry. 3. Please rate the candidate by checking the item under each heading which most nearly represents your evaluation: a. Physical Condition e. Leadership Frequently incapacitated Makes no effort to lead Somewhat below par Has leadership promise Fairly healthy Good leadership ability Rugged and vigorous Unusual ability to lead b. Physical Presentation f. Intelligence Avoided by others Learns & thinks slowly Tolerated by others Average mental ability Liked by others Alert good mind Sought by others Brilliant c. Emotional Stability g. Speaking Ability Somewhat over-emotional Has speech defect Usually well-balanced Poor speaker Well-balanced and controlled Has fair ability Maintains balance under difficult Good speaker circumstances Persuasive & eloquent d. Religious Experience h. Promise in the Ministry Relatively superficial Below average Over-emotional Average Genuine but mild Good Rich and growing Superior Profound and contagious Exceptional 4. List any limitations which would detract from applicant s usefulness in the ministry, such as personal appearance, habits, etc. 5. Summary paragraph of applicant s all-around fitness for the ministry. (Please use the back of this page.) Date: Name (Please Print) Signature: Occupation: Send directly to: Rev. June Jernigan at june@awfumc.org

18 THE UNITED METHODIST CHURCH MEDICAL REPORT OF MINISTERIAL CANDIDATE NOTE: THIS FORM IS NOT IN A FILLABLE FORMAT. MUST BE PRINTED OFF AND TURNED IN. Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: To the Board of Ordained Ministry: Please indicate here, the name/address of the board officer who will receive this report. Name: Address: Candidate Name: CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION COMPLETED BY CANDIDATE I hereby authorize and direct (physician) conference) information with regard to the records of (candidate) Date of Birth:, to disclose to the (annual Board of Ordained Ministry the following for the purpose of evaluation by The United Methodist Church for entrance into ministry. I, the undersigned, understand that I may revoke this consent at any time except to the extent that action has been taken in reliance upon it. This consent will expire sixty (60) days after the date treatment is terminated unless another date is specified. I understand that the information requested may be disclosed from records whose confidentiality is otherwise protected by federal as well as state law. Any of the above requested information may include results of alcohol/drug (substance) abuse and/or diagnosis and treatment of psychological disorders, as well as HIV status. To the party receiving this information: This information has been disclosed to you from records whose confidentiality is protected by federal law. Federal regulations (42 CFR Part 2) prohibit you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is not sufficient for this purpose. Signature of candidate Witness Date Date BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 1 Form 103/2013

19 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: Please note: The candidate s physician should make the final determination regarding the need for specific medical tests as related to the overall health and needs of the candidate. Part I: Personal History Report To be completed by the candidate. Medical problems experienced at any time by YOU or a first degree family member (mother, father, sister, brother, son or daughter): PROBLEMS YOU Any close family member Diabetes NO / YES NO / YES Hypertension NO / YES NO / YES High cholesterol NO / YES NO / YES Heart problems (specify) NO / YES NO / YES Asthma or emphysema NO / YES NO / YES Cancer (specify type) NO / YES NO / YES Anemia/excess bleeding/blood clots NO / YES NO / YES Arthritis/back pain NO / YES NO / YES Stomach/bowel problems NO / YES NO / YES Kidney/bladder problems NO / YES NO / YES Depression/ Anxiety NO / YES NO / YES Sleep apnea NO / YES NO / YES Stroke NO / YES NO / YES Sexually transmitted disease Other Surgeries in your lifetime: NO / YES Social History (list any past or present use of substances): Cigarettes NO / YES Packs per day #: Years smoking #: Cigars NO / YES Smokeless tobacco NO / YES Alcohol NO / YES Drinks per week (beers/wine/liquor) #: Recreational drugs NO / YES Substance used: IV drug use NO / YES Date: Results of last HIV test: BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 2 Form 103/2013

20 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: Part I, continued Health Behaviors: How often do you exercise 30 minutes in a day? almost never 1-4 days/ week 5 or more days/ week How often do you intentionally limit complex carbs/starches/sweets and fats in your diet? never sometimes always Have you ever been the victim of physical, emotional or sexual abuse in your lifetime? NO / YES If so, do you live/work in a safe environment now? Vaccination History: VACCINE (TIMING/AGE) Influenza (yearly) Tetanus/diphtheria/pertussis (TDAP) (every 10 years) Pneumonia vaccine (once over 65 years old) HPV series (women 9-26 years old) Shingles vaccine (once over 50 years old) Others DATE OR YEAR ADMINISTERED Tuberculosis Exposure History: Visitation/ mission work in hospitals, prisons, homeless shelters, nursing homes, underdeveloped countries or exposure to anyone with known TB infection? NO / YES If yes, when was your last TB screening test? Date: Results: BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 3 Form 103/2013

21 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: Part II: Physical Exam To be completed by examining provider. BIOMETRIC RESULT NORMAL RANGES Weight Height Waist measurement BMI lbs. inches inches Blood pressure <120/80 Pulse (Men < 40 inches, women <35 inches) <25 normal, overweight, obese, >40 extreme obesity SYSTEM HEENT Chest/lungs Heart/vascular Abdomen GU (prostate or pelvic exam if appropriate) Skin Joints/Spine Lymphatics Neurological Mood NORMAL / ABNORMAL (SPECIFY) / NA Labs/imaging: SCREENING TEST (age) RESULT DATE Fasting glucose Fasting Total cholesterol LDL HDL Triglycerides Last PAP smear (20-65) Last Mammogram (>40) Last PSA (men if desired) Last Colonoscopy (>50) Bone density (females >65) AAA screening (male smokers >65) BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 4 Form 103/2013

22 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: Part II, continued Health Assessment: Plan/Recommendations to candidate: Physician recommendations to the Board of Ordained Ministry related to candidate: Examining Provider: Address: Phone: Fax: Signature: Date: STAMP Medical Form Background Information BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 5 Form 103/2013

23 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: The following lists show standard screening practices on which this document is based. Additionally, the physician may choose to make recommendations to the candidate as needed based on the Key Points listed below. Key screening advice taken from large consensus groups like US preventative task force and evidence-based information: Screening Height and weight (periodically) Blood pressure Alcohol and tobacco use Depression (if appropriate follow-up is available) Diabetes mellitus (patients with hypertension) Dyslipidemia (total and HDL cholesterol): men 35 y; men or women 20 y who have cardiovascular risk factors; measure every 5 y if normal Colorectal cancer screening (men and women y) Mammogram every 1 to 2 y for all women 40 y. Evaluation for BRCA testing in high-risk women only. Papanicolaou test (at least every 3 y until age 65 y) Chlamydial infection (sexually active women 25 y and older at-risk women) Routine voluntary HIV screening (ages y) Bone mineral density test (women 65 y and at-risk women y) AAA screening (one time in men y who have ever smoked) Counseling Substance Abuse Tobacco cessation counseling Alcohol misuse: brief office behavioral counseling; alcohol abuse: referral for specialty treatment Counseling Diet and Exercise Behavioral dietary counseling in patients with hyperlipidemia, risks for CHD and other dietrelated chronic disease Regular physical activity (at least 30 minutes per day most days of the week) Intensive counseling/behavioral interventions for obese patients AAA = abdominal aortic aneurysm; BRCA = breast cancer susceptibility gene; CHD = coronary heart disease. Based on recommendations from the U.S. Preventive Services Task Force. BOM Handbook, Chapter 8, Candidacy and Candidacy Forms 6 Form 103/2013

24 Candidate s Last Name: First: Date of Birth (mm/dd/yyyy): Middle: Key Points The U.S. Preventive Services Task Force recommends routine periodic screening for hypertension, obesity, dyslipidemia (men 35 years), osteoporosis (women 65 years), abdominal aortic aneurysm (one-timescreening), depression, and HIV infection. The U.S. Preventive Services Task Force recommends routine periodic screening for colorectal cancer (persons years of age), breast cancer (women 40 years), and cervical cancer. The U.S. Preventive Services Task Force recommends that all pregnant women be screened for asymptomatic bacteriuria, iron-deficiency anemia, hepatitis B virus, and syphilis. The U.S. Preventive Services Task Force recommends against screening for hemochromatosis; carotid artery stenosis; coronary artery disease; herpes simplex virus; or testicular, ovarian, pancreatic, or bladder cancer. Outside of prenatal, preconception, and newborn care, genetic testing should not be performed in unselected populations because of lower clinical validity; potential for false positives; and potential for harm, including genetic labeling. For patients for whom genetic testing may be appropriate, referral for genetic counseling should be provided before and after testing. A human papillomavirus vaccine series is indicated in females ages 9 through 26 years, regardless of sexual activity, for prevention of cervical cancer. A single dose of tetanus-diphtheria acellular pertussis (Tdap) vaccine should be given to adults ages 19 through 64 years to replace the next tetanus-diphtheria toxoid (Td) booster. A zoster (shingles) vaccine is given to all patients 60 years and older regardless of history of prior shingles or varicella infection. Asymptomatic adults who plan to be physically active at the recommended levels do not need to consult with a physician prior to beginning exercise unless they have a specific medical question. Smoking status should be determined for all patients. Patients who want to quit smoking should be offered pharmacologic therapy in addition to counseling, including telephone quit lines. Routine screening is recommended to identify persons whose alcohol use puts them at risk. For management of alcohol abuse and dependence, referral for specialty treatment is recommended; for management of alcohol misuse, brief behavioral counseling may be useful.

25 Clues for chemical dependency include unexpected behavioral changes, acute intoxication, frequent job changes, unexplained financial problems, family history of substance abuse, frequent problems with law enforcement agencies, having a partner with substance abuse, and medical sequelae of drug abuse. Condom use reduces transmission of HIV, Chlamydia, gonorrhea, Trichomonas, herpes virus, and human papillomavirus. It is important to ask about domestic violence when patients present with symptoms or behaviors that may be associated with abuse. When an abusive situation is identified, address immediate safety needs.

26 Ministerial Effectiveness and Leadership Report NOTE: THIS FORM IS NOT IN A FILLABLE FORMAT. MUST BE PRINTED OFF AND TURNED IN. The following written report should be ed to Rev. Jernigan at june@awfumc.org. 1. Describe your family background, including family of origin. 2. Describe your educational and work history. 3. Describe your religious background, including the formative Christian experiences in your life. 4. Describe your call to ordained ministry and the fulfillment of your call in the United Methodist Church. 5. What distinguishes and unites the ministry of the laity, the deacon, and the elder? 6. Your call: A. For those whose call is to the ministry of the deacon: In reference to 328 of the 2012 Book of Discipline within your specific call and context of ministry, how do you interrelate the worship of the church with servanthood in the world? B. For those whose call is to the ministry of the elder: If you are applying for provisional membership, what will be the significance to you and your family for you to submit yourself to the itinerant ministry of the United Methodist Church? If you are applying for membership in full connection, how has your submission to the itinerant ministry of the United Methodist Church impacted you and your family, and what impact do you anticipate with your submission to itinerancy in the future? 7. Describe your gifts and graces for ordained ministry and how these gifts can benefit the church now and in the future. 8. Describe the disciplines in your life which will aid you in living a healthy life of physical, mental, economic, emotional, and spiritual wholeness.

27 Candidate: Please forward this form to your three Ministerial Recommendations. Click HERE for the link. Ministerial Recommendation To be filled out by clergy members (FE or FD) of the Alabama West Florida Annual Conference is applying to the Alabama-West Florida Conference of the United Methodist Church for Admission as a Provisional Elder. The Board of Ordained Ministry asks each applicant to secure the recommendation of three persons in Full Connection in the Conference. Please give your answers to each of the questions below, and if you can do so without reservation, sign the statement giving your endorsement to this applicant. 1. How long and under what circumstances have you known the applicant? 2. Are you convinced that this applicant is genuinely called of God to the ministry? Yes No (If No, please give your reasons on the back of this sheet.) 3. Are you convinced that this applicant is totally committed to the doctrines and policies of the United Methodist Church? Yes No (If No, please give your reasons on the back of this sheet.) 4. What personal strengths do you see in this applicant that fit him/her for the ministry? (Use back of sheet for additional comments) 5. What personal weaknesses concern you about the applicant that you think the Board of Ordained Ministry should discuss with him/her as guidance is given for the applicant s future? (Use back of sheet for additional comments) Endorsement: I give my full endorsement to as a candidate for Provisional Elder in the Alabama-West Florida Conference. Name Please Print Signed: Dated: (If you cannot give your endorsement to this applicant, please give your reasons on the back of this sheet.) Please send this form directly to Rev. June Jernigan at june@awfumc.org

28 Candidate: Please forward this form to your PPR/SPRC Chair. Click HERE for the link. Pastor Parish Relations/Staff Parish Relations Evaluation is applying to the Alabama-West Florida Conference of the United Methodist Church for admission as a Provisional Elder. The Board of Ordained Ministry asks that the Pastor/Staff Parish Relations Committee give an evaluation of the applicant s ministerial leadership. While the final judgment regarding recommending the applicant to the Conference rests with the Board of Ordained Ministry, your evaluation is needed and will be helpful in advising the applicant regarding his/her future ministry. This form should be filled out at an announced, called meeting of the Pastor/Staff Parish Relations Committee of your charge. Review and discuss the form before you begin to fill it out. Give your prayerful, well-considered answers to each question. If you have questions about the form, or about the process that you are involved in, please contact the Director of Ministerial Services listed at the end of this form. Name of Church/Charge: Date and Place of PPR/SPR Committee meeting at which this form was completed: Number of committee members involved in completing this form: Number of committee members absent and not involved: Pastor/Staff Parish Committee Chairperson: Name: Address: Phone: 1. How long has the applicant served your church/charge? 2. Give your evaluation of the applicant s personality, character, and ability: Above Below Superior Average Average Average Poor Personal Appearance Ability to get along with people Ability as a preacher Emotional maturity and stability Leadership ability in the church

29 3. Does he/she understand, believe in, and urge full support of the programs and ministries of the United Methodist Church? Yes No (If No, give details below.) 4. Have there been major problems in the life of your church this year that in the opinion of your committee are the results of the ministry of the applicant? Yes No (If Yes, give details below.) 5. In the opinion of your committee, what are the major strengths of the applicant as a minister? (Please give details below.) 6. What personal weaknesses concern you about the applicant that you feel the Board of Ordained Ministry should discuss with him/her as guidance is given for the applicant s future ministry? (Please write details below.) Please send this form directly to Rev. June Jernigan june@awfumc.org

30 Self-Evaluation and Report of Progress in Ministry to Rev. June Jernigan at For Conference Year beginning July 1, 2014 Name Today s Date: Address City State Zip I. EDUCATION: By the next Annual Conference Session, I shall have completed the following amount of work on my education: Number of college hours completed: II. Explain the TYPE OF WORK in the church in which you are presently involved (serving a charge, etc.) and how you feel about this work: III. FAMILY: How does your family feel about your present situation in preparation for your ministry? Have there been any changes in your marital status, or do you expect any changes? IV. Describe your personal DEVOTIONAL LIFE:

31 V. How would you EVALUATE YOURSELF (your spiritual growth, your needs, etc.) during this year? VI. Give a brief sketch of your PLANS FOR THE FUTURE: For the next 6 months: Where do you hope to be in your ministry 5 years from now? VII. What help can the Board of Ordained Ministry be to you? Can we help you meet some need? Do you have any suggestions to us about our work with you?

32 Choose one passage: Guidelines for Sermon for Provisional Elders Genesis 1:1 2:4a; Psalm 8; 2 Corinthians 13:11 13; Matthew 28:16-20 You are to prepare and deliver a sermon based on one of the above prescribed texts and submit the full manuscript (not transcript), worship bulletin or worship plan, and a DVD video of the worship service. You may also Rev. Jernigan a digital copy of your presentation, but the DVD must still be submitted. The purpose of this requirement is to place emphasis upon the pastor s need to be effective in preparing and delivering sermons. The committee will be evaluating your level of understanding of the Biblical passage, your commitment to effectiveness in preaching the Word of God, and your comfort/anxiety level in preaching and leading worship in a United Methodist Church. Please follow these guidelines in fulfilling this requirement: 1. You should include a sermon title, which reflects the main theme of the sermon, as well as a statement of purpose that discloses what you anticipate the congregation will take with them or do after hearing the sermon. 2. The sermon should be neither shorter than fifteen minutes nor longer than twenty-five minutes, and the manuscript (not transcript) should not exceed eight typed, double-spaced pages. all work to june@awfumc.org. 3. You should submit a clear DVD video of the entire worship service in which you preached the sermon. The DVD may be of you preaching the sermon for a class or in another setting if it is not possible for you to preach the sermon in a worship setting. View your recording! Make sure the level of quality of the DVD is what you think should be submitted to the BOM. 4. You should submit a description of the worship setting, along with a copy of the worship bulletin or the plan of worship. 5. You should arrange in advance to have three adult congregation members evaluate the sermon. (These evaluations are included in the file of materials you downloaded from the conference web site.) 6. As with any professional work, careful attention should be given to proper grammar and spelling. Again, the video recording should be of good quality. 7. You are to bring a copy of your sermon manuscript with you to the interview. Please note: If your work does not include all of the items listed, the requirements for this area will not have been met.

33 Candidate: Please forward this form to your Evaluators. Click HERE for the link. SERMON EVALUATION FOR Applicant's Name Directions: Be candid and frank in your ratings and comments. This will be used to help the applicant. Circle the appropriate number on a scale from 1-10 (10 being best) and comment on each section. Send the completed form directly to: Rev. June Jernigan at june@awfumc.org Do not return this form to the applicant. 1. Was the central thought (the big idea) of the sermon clearly presented? Comments: 2. Did the sermon do justice to the text and draw out its meaning? Was it biblical? Comments: 3. Was the message in the sermon applicable? Did it speak to something in your life? Comments: 4. Was the preacher's body language and presentation through gestures, eye contact, posture, etc. effective? Comments: 5. Was the development (structure and movement) apparent? Comments: 6. How would you rate the sermon as a whole? Comments: Name Signature (Please Print) Dated: Thank you for your assistance. Should you have any questions, please call Rev. June Jernigan at (334)

34 The UMC Candidate s Disclosure Form (PE) NOTE: THIS FORM IS NOT IN A FILLABLE FORMAT. MUST BE PRINTED OFF AND TURNED IN. Please complete this form, sign and date it, have your signature notarized, and return it with all your other forms to Rev. June Jernigan, 4719 Woodmere Boulevard, Montgomery, AL Have you ever been: 1. Convicted of a felony? No Yes 2. Convicted of a misdemeanor? No Yes 3. Accused in writing of sexual misconduct or child abuse No Yes If you answered Yes to any of these questions, please explain: (Attach a separate piece of paper.) If you are required by this disclosure form to disclose any written accusations or convictions for felony, misdemeanor or any incident of sexual misconduct that you dispute or believe should be explained in any way, you have an opportunity at this time to include any additional information that you believe might be helpful or important regarding the disclosure. Any relevant additional information should be provided in a response statement attached to this form. (Note: It would be preferable if this response statement could be included right on the disclosure statement, however we realize there are space limitations on forms and thus you might need to request that the statement be attached. Please indicate if pages are attached.) I hereby certify that the information provided on this form is true and accurate. Print Name Signature Subscribed and Sworn this day of, 20 Notary Public Printed Name Notary Public Signature Notary Public, State of, My Commission Expires Note: You are to have an official background check on file. To initiate this process, please contact Rev. June Jernigan as soon as possible and she will guide you through what you need to do. You may her at june@awfumc.org.