Annual Report Form

Date

Full Name

Address

Office Telephone

Home Telephone

Mark if new address or phone:

Preferred e-mail

Canonically resident in:

Occupation:

Please summarize your ministry during the past year:

Celebration of
Holy Communion:

Assistant at
Holy Communion:

Morning and
Evening Prayer:

Baptisms:

Marriages:

Burials:

Number of sermons:

Other:

If you are assisting in a parish or mission, please list the parish and describe your work:

If you are not assisting, where do you regularly worship?

Are you pledging to the work of the church?

Yes No

Do you want to be on the Diocesan supply clergy list?

Yes No

If yes, state your availability and in which churches or what area you would do supply work:

List skills you are willing to share in the diocese at the Bishop's request:

Please indicate whether you have completed the training in prevention of adult sexual misconduct and child sexual abuse in church settings:

Adult Sexual Misconduct
Prevention Training
If yes, date:

Yes No

Child Sexual Abuse
Prevention Training
If yes, date:

Yes No

Special notes/concerns you would like to share with the Bishop: