"*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.Section 1: General InformationName* First Last Are you a bishop, priest or deacon?* Priest Deacon Bishop Email* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is any of the information listed above new?* Yes No Section 2: Summary of Ministry for Prior YearDid you exercise your ordained ministry in 2025?* Yes No If your answer is yes, please summarize your ministry in Section 2.1 (approximate numbers are acceptable). If your answer is no, please skip to Section 2.2Section 2.1All records of my ordained ministry for the previous year are in parish records This statement applies to me (skip to section 3) This statement does not apply to me (answer additional questions, below) Celebration of Holy CommunionAssistant at Holy CommunionMorning or Evening Prayer ServicesMarriagesSermonsPresented for ConfirmationBaptismsBurialsPastoral VisitsHospital VisitsLectures/Seminars/ClassesCounseling SessionsChurch MeetingsOtherSection 2.2If you answered no to the question in Section 2, please state the reason(s) which prevented you from exercising your ministry: I am retired I had health issues Other (please explain, below) Other reason(s):Section 3: Additional information/commentsIf you have information/comments you'd like to share with the bishop, please enter them below.Section 4: Safe Church, Safe Communities TrainingSafe Church, Safe Communities online training sessions are required for leadership positions across the diocese, setting forth expectations and fostering the highest standards of behavior in ministry settings. As a non-parochial or licensed member of our clergy, record of your completion of the following training modules must be on file in our office for you to be considered for supply work and/or for you to be licensed to officiate in this diocese: • Universal Training • Specialty Training • Supervisor TrainingHave you completed these Safe Church, Safe Communities training items in the past three years? Yes No If your answer is yes, complete the following questions. If you answer is no, please contact the Human Resources Administrator and Finance Assistant (hr-finasst@diowestmo.org) to request access to the Safe Church, Safe Community online coursework. To be considered a clergy person in good standing, this training must be complete by June 1, 2026.If yes, in which diocese?If your training was completed in a different diocese, please forward a copy of your certificate(s) of training to the Human Resources Administrator and Finance Assistant (hr-finasst@diowestmo.org) or mail via USPS. If yes, what email address did you use for your Safe Church, Safe Communities training?Section 5: Diversity TrainingAs a non-parochial or licensed member of our clergy, record of your completion of a Diversity Training Course within the past five years is required for you to be considered for supply work and/or for you to be licensed to officiate in this diocese.Have you completed a Diversity Training Course within the past five years? Yes No If your answer is yes, complete the questions below. If your answer is no, please watch the "events" page of our website for these classes to be announced (they are held in the spring and fall). To be considered a clergy person in good standing, this training must be complete by February 28, 2027.If yes, in which diocese?If your diversity training was completed in a different diocese, please forward a copy of your certificate/proof of training to the Human Resources Administrator and Finance Assistant (hr-finasst@diowestmo.org) or mail via USPS. Section 6: Supply WorkIf willing to supply in the diocese, please indicate which deanery/deaneries you are interested in supplying: Central Northwest-Metro Southern Select AllPlease note: by indicating interest in supply work, your e-mail address and phone number will be published on our diocesan website.SignatureThis is the end of the non-parochial form for canonically resident clergy. Non-canonically resident members of clergy - please continue below.Section 7: Non-Canonically Resident Clergy ONLYI am canonically resident in the diocese of:As a non-canonically resident clergy person, I wish to be relicensed to officiate in the Diocese of West Missouri for the year 2026. Yes No (NOTE: if previously licensed, failure to complete this request will result in license expiration)
