Kentucky East 2020 Charge Conference Form - Appointment to an Extension Ministry

Please note that all questions marked with an asterisk (*) are required fields.

If a required question does not pertain to you, or you do not have that information at the time you are filling out this form, please input "N/A" in the blank field. 

When you complete with the form, make sure to click 'Save Form'.  The form will not be submitted and be saved if you have left any required questions (those marked with an asterick) blank.  You may return at any time to make changes.


(This form is to be filled out annually with a copy of current performance evaluation.)

Please list your business address below.

*First Name
*Last Name
*Address 1
Address 2
Which address would you prefer for mailing purposes and for inclusion in the Journal?
No answer

Please enter date as: MM/DD/YYY - example 07/01/2017

Phone (office):
Phone (residence):
Phone (cell):
*Present Appointment:
*Which are you?
Full Member
Probationary Member
Associate Member
*You are a member of which Annual Conference?
*Charge Conference Membership
Under Appointment Outside of Your Conference?

If you are under appointment outside the Conference of which you are a member, please complete the following:

Conference where you serve:
Bishop of that Conference:
District Superintendent:
Affiliate charge conference membership:
Base Compensation:

(Year _____________ ) $_____________

Utilities and Other Housing Related Allowances:
Travel Allowance:
Other Cash Allowances:
*Please Indicate Your Appointment Category:

(¶ 334.1, 2012 Book of Discipline)

Appointed within the connectional structure
Endorsed by the General Board of Higher Education and Ministry
In service with General Board of Global Ministries
Appointed to other valid approved extension ministry


*Appointment Request:
RETURN - I would like the Bishop to reappoint me to my present appointment.
MOVE - I would like a change of appointment.
EITHER - I am open to being moved to a new appointment or returned to this appointment.
N/A - not applicable.
*Would you like to discuss this appointment request with the superintendent?


Brief Narrative

In the space below, please provide a brief narrative of your ministry during the past year including a description of your annual evaluation or, if this is in a separate file, upload that file using the link in the next question.

Upload files:

Upload any files that relate to a brief narrative of your ministry during the past year including a description of your annual evaluation and/or evidence of your continuing education and spiritual growth program and future plans. (¶ 334.2, 2012 Book of Discipline).

Attach file pdf, doc(x), xls(x), jpg/gif/png, ppt - up to 25 MB


*Signature By signing this form, you are acknowledging that all the information above is accurate.

Enter your name below. By typing your name and signing in the area below you are verifying your name and date of this signature

Draw your signature below.
clear signature

Send Copies to: 1) Bishop, 2) District Superintendent, 3) Board of Ordained Ministry, 4) Bishop of area in which you serve, if other than area of which you are a member, 5) Conference Secretary.


Copies of this report may also be used to inform the United Methodist Endorsing Agency and the Charge Conference(s) of which you are a member and an affiliate member in keeping with ¶ 335.3 a,b.

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If you are NOT done, you can simply press the save button and edit the form later.


When you complete this form, make sure to click 'Save Form'. You may return at any time before the deadline to make changes.


Revised July 2020

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