Title *

First Name *

Last Name *

Mailing Address 1

Mailing Address Line 2

Mailing City

Mailing State

Mailing Zip Code

Primary Email Address *

Mobile Phone *

Congregation Membership * Alleluia!, NapervilleAlpine, RockfordAll Saints, ByronAugustana, AndoverBecoming, OswegoBethany, Crystal LakeBethany, LelandBethany, WoodhullBethel, StronghurstBethesda, MorrisonBethlehem, DeKalbBethlehem, JolietBethlehem, RockfordCalvary, MolineCalvary, New WindsorCalvary, RockfordCambridge, CambridgeCapron, CapronChrist, BelvidereChrist, StocktonCross & Crown, RoscoeCross of Glory, Homer GlenEmmanuel, OregonEmmanuel, RockfordEmmaus, McNabbFaith, ForrestonFaith, JolietFaith, RochelleFaith, South BeloitFaith, WatagaFirst, ChadwickFirst, DeKalbFirst, FreeportFirst, GalesburgFirst, GeneseoFirst, GranvilleFirst, JolietFirst, LeeFirst, MolineFirst, MonmouthFirst, Mt CarrollFirst, OhioFirst, PecatonicaFirst, PlanoFirst, ProphetstownFirst, RockfordFirst, Rock IslandFirst, SherrardFirst, SterlingFollowers of Christ, PlainfieldFreedom, OregonGrace, KnoxvilleGrace, Loves ParkGrace, RichmondGrace, WilmingtonGrace, WoodstockGood Shepherd, LenaGPS, Machesney ParkHeart of Illinois ParishIglesia San Jose Obrero, MolineIllinois River Valley ParishImmanuel, AmboyImmanuel, ComptonImmanuel, DixonImmanuel, EarlvilleImmanuel, MarseillesImmanuel, PeruImmanuel, Rock FallsImmanuel, YorkvilleJoliet, BethlehemJoyful Harvest, JohnsburgJoyful Spirit, BolingbrookLight of Christ, AlgonquinLiving Waters, Crystal LakeLord of Love, GalenaLutheran Church of the Good Shepherd, RockfordMessiah, AledoMessiah, GalesburgMessiah, GalvaMessiah, Port ByronNativity, Wonder LakeNew Life, BolingbrookOur Savior's, RockfordOur Savior's, SenecaOur Saviour, SandwichPlattville, MinookaPrince of Peace, FreeportPeace, MorrisPeace, New LenoxPeace, Port ByronRedeemer, KewaneeRedeemer, WoodstockResurrection, ChannahonSalem, MolineSalem, RockfordSalem, SandwichSalem, SycamoreSanta Cruz, JolietScenic Hills ParishShepherd of the Hill, LockportShepherd of the Hills, McHenryShepherd of the Hills, Scales MoundShepherd of the Prairie, HuntleyShepherd of the Valley, RockfordSt. Barnabas, CarySt. James, ForrestonSt. James, Rock IslandSt. John's, AshtonSt. John's, CrestonSt. John, ElizabethSt. John's, HebronSt. John, JolietSt. John's, MendotaSt. John's, Pearl CitySt. John's, PeruSt. John's, PrincetonSt. John's, Rock IslandSt. John's, SomonaukSt. John, SterlingSt. Mark, RockfordSt. Mark's, PoloSt. Matthew's, PrincetonSt. Paul, DixonSt. Paul, HanoverSt. Paul, KentSt. Paul, OrionSt. Paul, SterlingSt. Paul, StreatorSt. Paul's, TonicaSt. Paul's, WarrenSwedona, Lynn CenterTrinity, DurandTrinity, ElizabethTrinity, GalesburgTrinity, HarvardTrinity, LanarkTrinity, ManliusTrinity, MilledgevilleTrinity, MolineTrinity, Mt MorrisTrinity, OttawaTrinity, RockfordUnited, GardnerUnited, RockfordZion, BelvidereZion, KewaneeZion, North HendersonZion, RockfordOther ELCA congregation outside the NISOther denominationNorthern Illinois SynodMosaicLutheran Social Services of IllinoisELCA Director of Mission SupportLutherdalePortico Benefit ServicesSt. Olaf CollegeELCA FoundationMission Investment

Occupation *

Gender *

If you wish to expand on "Other/Prefer not to answer," please do so here

What pronouns do you use? *

Age at time of election: June 14, 2025 *

Primary language *

Race/Ethic Origin/Ethnicity *

Synod Council and Committee members to be elected at the 2025 Synod Assembly.

Please list areas of special leadership and interest in your congregation(s), both past and present. *

Please list areas of special leadership and interest in the community, both past and present. *

Why do you wish to serve in this area of ministry in the Synod? *

What are your priorities for this ministry? *

Please share a brief statement of faith. *