ANNUAL REPORT TO THE BISHOP FORM

Form for clergy licensed to officiate in the Diocese of Washington.

Date(Required)

Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Office Phone

Mobile Phone

Untitled

Check if new address or phone

Preferred Email

Canonically resident in:

Occupation:

Please summarize your ministry during the past year:

Celebration of Holy Communion:

Assistant at Holy Communion:

Evening and Morning 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

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

Yes

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 *(Required)

Yes

If you have attended Adult Sexual Misconduct Training, indicate the date:

Child Sexual Abuse Prevention Training *(Required)

Yes

If you have attended Child Sexual Misconduct Training, indicate the date:

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

ANNUAL REPORT TO THE BISHOP FORM

Please summarize your ministry during the past year:

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

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