District Committee on Ordained Ministry

Action Report to the BOM Registrar

Date:

Select the appropriate district.

☐	Brookhaven	☐	East Jackson	☐	Greenwood
☐	Hattiesburg	☐	Meridian	☐	New Albany
☐	Seashore	☐	Senatobia	☐	Starkville
☐	Tupelo	☐	West Jackson
Full Legal Name:	Cell Number:
Street Address:
City:	State:	Zip:
Email:

(PLEASE CHECK ONE---IF NOT CHECKED, FORM WILL BE RETURNED)

☐	Exploring Candidate	☐	Continuance Certified Candidate	☐	Associated Membership
☐	Transitional Candidate	☐	Full Time Local Pastor	☐	Provisional Membership
☐	Declaring Candidate	☐	Part Time Local Pastor	☐	Certified Lay Minister
☐	Certified Candidate	☐	Reinstated	☐	Discontinued

The District Committee on Ordained Ministry took the following action(s)

regarding the person listed above. [Check the appropriate action (s)]

Before becoming a certified candidate one must first attend the Next Phase Retreat. Please indicate the date the candidate participated in this retreat ___/_____/______.
Candidate certified the year 2016 or before is exempt from attending the Next Phase Retreat. Date Certified: ___/____/______

The following information will be used in the preparation of The Business of The Annual Conference. This information will require a vote at annual conference, therefore accuracy is a must. Please note: The statements below are numbered according to the listing in the Mississippi Annual Conference Official Journal and Yearbook.

19.	Certified Candidates (¶¶310, 313, 314)
☐	Currently certified as a candidate for ordained or licensed ministry.
Date Certified:
☐	Candidate for ordained or licensed ministry accepted by a dCOM in another annual conference.
Conference Name:	Date
☐	Discontinued as a certified candidate for licensed or ordained ministry.
Date certified:	Date discontinued:
☐	Certified candidate in this conference serving in another conference.
Date certified:	Date discontinued:
20.	Certified candidate who have completed the studies for the license as a local pastor, are approved, but are not now appointed (¶315).
Year Awarded:

Recommended to the BOM with the approval for appointment. (PLEASE NOTE: This person must be receiving an appointment) (Also, indicate with an asterisk if completed the five year course of study or the M.Div.):
a.	☐	As a full time local pastor (¶318.1). The first-year license was awarded
# of courses of study (CsOS) or the name of the seminary enrolled in
# of years in course of study or the name of the seminary enrolled in and
(Please provided both: # of CsOS/seminary and # of years in COS/seminary)
b.	☐	As a part-time local pastor (¶318.2). The first-year license was awarded.
# of courses of study or the name of the seminary enrolled in
# of years in course of study or the name of the seminary enrolled in and
(Please provided both: # of CsOS /seminary and # of years in COS/seminary)
c.	☐	Student from another annual conference or denomination serving as a local pastor and enrolled in a school of theology listed by the Univ. Senate (¶318.3, 4). The first-year license was awarded
# of years in course of study or the name of the seminary enrolled in
d.	☐	Students who have been certified as candidates in your annual conference who are local pastors in another annual conference while in enrolled in a seminary listed by the University Senate (¶318.3). The first-year license was awarded
# of years in course of study or the name of the seminary enrolled in
e.	☐	Persons serving as local pastors while seeking readmission to conference membership (¶¶366.4, 367,369.3)
(If not in this conference indicate name of conference where serving)
# of years in course of study
22.	Discontinued as a local pastor (¶320.1).	Date discontinued
23.	Reinstated as a local pastor. # of years of course of study
30.	Ordained clergy, coming from other Christian denominations, have their orders recognized. Clergy Status ___________ Previous Denomination _______________________________
31. (b)	Ordained clergy received from other Christian denominations (¶347.3) as a local pastor. Clergy Status _____________ Date Received _____________ Former Denomination ________________
27.	Recommended for associate membership (¶322).
28.	Recommended for election to provisional membership and seminary if attending school (under ¶¶ 322.4, 324, 325).
a.	☐	Provisional Deacon under the provisions of ¶¶324.4a, c or ¶325.5. Seminary
b.	☐	Provisionals Elder under the provisions of ¶¶324.4a, b or ¶322.4. Seminary
31. (a)	Ordained clergy received from other Christian denominations (¶347.3c) as a provisional member. Clergy Status _____________ Date Received _____________ Former Denomination ________________
35.	Provisional member previously discontinued and readmitted (¶365).
Clergy status	Years completed in COS
36.	Readmitted (366-368,369)
a.	☐	After honorable or administrative location (¶366).
Clergy status	Previous Status
b.	☐	After exit of ministerial office (¶367).
Clergy Status	Previous Status
c.	☐	After termination by action of the annual conference (¶368).
Clergy Status	Previous Status

______________________________________________________________________________________________________

(dCOM ACTION REPORT IS INCOMPLETED UNTIL THE FOLLOWING ARE DONE)

_______________________________	____________________	____________	____________________

Signature of dCOM Chair or Registrar	Cell # (with area code)	Date	Email

_______________________________	___________

Signature of the District Superintendent	Date

Please mail report to: The Office of Spiritual Leadership | Dorothy Ellis, Conference Registrar | 320 D Briarwood Drive|Jackson,

Mississippi 39206 and/or email to: confregistrar@mississippi-umc.org.

Thank you!