28th June, 2011 - Posted by admin - Comments Off

Step 1: The Clergy License Application

Our process allows for 90% of this application to be completed online.

1. I am applying for:
2. Active 2012 License to Practice Retired 2012 Limited License to Practice

Section 1a: Contact Information

1. Preferred Title Mr. Miss Mrs. Ms. Rev. Rev. Dr. Rev. Elder The Right Reverend none of these
2. First Name(required)
3. Last Name(required)
4. Street Mailing Address
5. City, State/Province
6. Postal Code
7. Country United States Canada
8. Full Physical Address (if different)
9. Home Phone
10. Cell Phone
11. Work Phone
12. Email Address(valid email required)

Section 1b: Personal Information

1. Date of Birth (DD/MM/YYYY)(required)
2. Social Security Number
3. (Optional) Sexual Orientation Bisexual Heterosexual Homosexual None of These
4. (Optional) Gender Identification Female/Woman FTM Gender Non-Conforming Genderqueer Male/Man MTF Transgender Trans-Identified Transsexual None of These
5. (Optional) Race

Section 2: MCC Involvement

1. Year of Ordination
2. Year began working as an MCC Clergy (paid or unpaid)
3. Are you a participant in the UFMCC Board of Pensions?
4. Yes No
5. Hours worked per week
6. You must complete at least 625 hours per year (approximately 12 hours per week) to be eligible for participation in the Board of Pensions.
7. Active member of which MCC
8. In what ways are you active in this local congregation?

Section 3: Triple A Ministry

1. What is your current Triple A (Authorized, Active, Accountable) ministry in MCC? (eg. Sr. Pastor, Elder, Chaplain, Staff Pastor, etc.)
2. Where do you perform this Triple A Ministry?
3. Beginning date of your Triple A Ministry at this location?
4. If you are a Chaplain, do you have an application to serve as MCC Chaplain on file with the Office of Formation and Leadership Development?
5. Yes No Not Applicable

Section 4: Application Signatures and Verification

1. I declare that the information in this form concerning my status, the position held, and the hours per week is true and accurate. Should I furnish any false information, I hereby agree that such shall constitute cause for disciplinary action, including suspension or revocation of any credentials in the UFMCC.
2. Signature Full Name(required)
3. Date of Signature(required)
4. By checking this box, I certify this application is true and correct to the best of my knowledge and I have signed it electronically in good faith.

Section 5: Additional Questions

1. PLEASE ANSWER THE FOLLOWING QUESTIONS
2. Have you ever been refused a professional license?
3. Yes No
4. Have you ever been convicted of a felony or misdemeanor other than minor traffic violations?
5. Yes No
6. Have you now or ever had incidents where the use of alcohol, stimulants, or habit-forming drugs has interfered with your work?
7. Yes No
8. Have you ever been the subject of disciplinary action by an employer or licensing organization alleging sexual or ethical misconduct?
9. Yes No
10. If your answer to any of the following questions is in the affirmative and you have not previously disclosed the details to the MCC Office of Formation and Leadership Development, please provide details below.
11. Affirmative Answer Details
12. WARNING: By your signature below you understand and agree that an investigation of any or all of these matters may be conducted by UFMCC to determine your continuing eligibility to pastor within MCC. You also understand and agree that you will be subject to an immediate defacto removal of your license/credentials if it is later determined that your answer to any of the above questions in Section 5 was false.
13. Signature Full Name(required)
14. Date of Signature(required)
15. By checking this box, I certify this application is true and correct to the best of my knowledge and I have signed it electronically in good faith.
16. Check this box to receive a copy of your application.
17. Form Verification (Type the code you see into the box)

 

form powered by cforms

OFFLINE RENEWAL PROCESS

If you would rather submit your renewal forms via postal mail, email or fax, you may download the 2012 Clergy Renewal form below.
DO NOT submit the  form below if you intend to complete the downloadable form.

Click on the link below to view the form or right-click to download and save the form to your computer.

2012 Clergy License Renewal Form