App 25 Application: Request to Continue Previously Approved Status Less Than Full Time (LFT) Service Name: Address:
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First
Middle
Street
City
Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work Email:
Last
______________________________________________________________________ Birthdate:
State
Zip
_________ _________ __________ Month
Day
Year
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Clergy Status: [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member District:
[__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR
Charge:
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Having been previously approved, I would like to request that I remain on: Less than Full Time serving [__] 1/4 Time [__] 1/2 Time [__] 3/4 Time Please remember that this request should be submitted by February 1st of each calendar year. __________________________ Signature
_________________________ Printed Name
___________________ Date
Office Use: Annual Conference Clergy Session __________ [__] did / [__] did not approve this request. AC Year Please submit to: [__] Your District Superintendent [__] The Office of Clergy Services via ClergyServices@holston.org 1 of 1
Updated: 2024-02