On Leave From Call Application • Northern Illinois Synod

First Name

Last Name

Date

You are called as a:

Email Address

Address

Address Line 2

City

Zip Code

Home Phone

Mobile Phone

Ordination Anniversary

Primary Ministry Site Serving:

Date of the last day you will be serving under call:

Reason for going on leave from call?

Are you open to a call in the future?

If you are open for a new call when would you be available?

In what city and congregation do you plan to transfer your membership?

Please describe your ability and willingness to provide ministry services at the direction of the Bishop while on leave from call:

By typing your name below you are hereby authorizing it to serve as your signature:

Date of signature: