Fillable Form 102: BIOGRAPHICAL INFORMATION FORM (The United Methodist Church Michigan Conference)

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Form 102: BIOGRAPHICAL INFORMATION FORM (The United Methodist Church Michigan Conference)

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BIOGRAPHICAL INFORMATION FORM
Form 102
Name: _____________________________________
__________________________________________
First Middle Last
Address: _____________________________
________________________________________________
Street City State Zip
Cell Phone: (_____) _______________________ Other Phone: (_____) __________________________
Sex: Male Female Birth
Date: ____________________________________
E-mail:_____________________________________
__________________________________________
Ethnic Origin:
Asian
African American/Black
White/Caucasian
Conference: ________
_________________________ District: __________________________________
Local Church: __
______________________________________________________________________
Church Address:
______________________________________________________________________
Street City State Zip
Briefly desc
ribe your involvement in your local church, such as your leadership positions, groups you enjoy,
church activities, etc.
Hispanic/Latin
o
Other:
Native Hawaiian/Pacific Islander American Indian
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Describe your church involvement in activities beyond your local church, such as district or annual conference
work, church camps, workshops, outreach, etc.
Educational Background
Dates
Attended
Degree or # of
Credit Hours
High School
College
Graduate School
Theological Seminary
Course of Study
Yr. 1 Yr. 2
Yr. 3 Yr. 4
Yr. 5
Adv. Course of Study
Credit Hrs:
Single (never married)
Widowed
Separated
Divorced
If married, please indicate your spouse’s information.
Name: ____________________
___________________________________________________________
First Middle Last
Birth Date: _________
________________________ Marriage Date: ____________________________
Spouse’s Occupation: ___________________________________________________________________
Your children, if
any:
Child’s Name
Date of Birth
Sex/Gender
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Marital Status:
Married (first marriage)
Married (second marriage or more)
Additional de
pendents, if any:
Dependent’s Name
Date of Birth
Sex/Gender
Education
Describ
e 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 Relati
on Age
Marital
Status
Education Sex/Gender Occupation
Father
Mother
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Work Experience: (current employment, previous employment, and military experience, if any.)
Have you previously served as a local pastor, diaconal minister, deacon, or elder in The United Methodist
Church?
Yes No
If Yes, What Conference? __________________________________________________
Conference Re
lationship
DATE
DATE
Diaconal Minister
Provisional Member
Local Pastor
Deacon in Full
Connection
Associate Member
Elder in Full Connection
Have you had a change in clergy relationship with a conference of The United Methodist Church?
Yes No
Change in Conference Relationship
DATE DATE
Discontinuance Administrative Location
Leave of Absence Honorable Location
Medical Leave Retirement
Termination by Annual
Conference Action
Withdrawal
Note: If additional space is needed please use a separate sheet of paper and attach this form.
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Form 102: BIOGRAPHICAL INFORMATION FORM (The United Methodist Church Michigan Conference)

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Completed 23 August 2021

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