Application to go on Voluntary Leave of Absence (VLOA)
Name: First Middle Last Address: Street City State Zip
Best Contact # (______)________-__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year
Email:
Clergy Status: [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member District: [__] AP [__] CM [__] NR [__] SS [__] SM [__] TV Charge:
After review ¶353 of the 2016 Book of Discipline, I would like to request: [__] Personal LOA [__] Family LOA [__] Transitional LOA
Initial the following:
______ I have attached a written request stating the detailed reasons for my request. ______ I signify that I have read ¶354 of the 2020/2024 Book of Discipline and that I have read the Frequently Asked Questions section that is part of this application document. ______ I further signify that I understand the process and the implications related to my request to enter into a Voluntary Leave of Absence Status with the Holston Annual Conference.
I desire for this leave to become effective: _________ _________ __________ Month Day Year
Please remember that this request should be submitted 90 days prior to the above-mentioned date.
Signature
Printed Name
Date
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org [__] Current District Superintendent
1 of 1
2025-07