Local Church Leadership Report

Local Church Leadership Report

Must be submitted by May 31
Church Information
Church Name *
As Listed in District Conference Journal and in the Portal
Have you already verified/updated Church Location Address and Mailing Address and contact information via the Pastor Portal? *

Yes No
Location Address *
Physical Gathering Place for Services
Location City *
City
Location ST *
State
Location Zip *
Zip Code
Mailing Address *
Where Mail Will Be Opened and Distributed In Timely Manner
Mailing City *
City
Mailing ST *
State
Mailing Zip *
Zip Code
Church Phone Number
Church Website
Church Facebook
Service Times | Gatherings
Sunday School? *

Yes No
Sunday School Time *

: Hour Minutes
Sunday AM Worship? *

Yes No
Sunday AM Worship Time *

: Hour Minutes
Sunday PM Service? *

Yes No
Sunday PM Service Time *

: Hour Minutes
Midweek Service? *

Yes No
Midweek Service Day *
Midweek Service Time *

: Hour Minutes
Kids/Youth Ministries Time

: Hour Minutes
Misc Notes | Comments
Pastor and Spouse Information
Have you already updated Pastor and Spouse information via the Pastor Portal? *

Yes No
Pastor's Name *

First Name Last Name
Pastor's Address *
Pastor's City *
City
Pastor's ST *
State
Pastor's Zip *
Zip Code
Pastor's E-mail *
Pastor's Mobile
Pastor's Home Number
Pastor's Date of Birth *

/ Month / Day Year
Spouse's Name

First Name Last Name
Spouse's E-mail
Spouse's Mobile
Spouse's DOB

/ Month / Day Year
Pastor's Children's Names and Dates of Birth...
If children still reside at home
If you have a paid Assistant, Associate, or Youth Pastor, please provide the same info above for each one on staff. Please include Name, Address, DOB, Email, & Mobile # for each hired Staff Person and his/her Spouse.
Staff Members and Spouse Info
Primary Church Officers

Required Information
Have you already updated primary Church Officers (Vice-Chair, LBA Secretary, Church Treasurer) contact information via the Pastor Portal? *

Yes No
Vice-Chair
Do you have a Vice-Chair? *

Yes No
VC Name *

First Name Last Name
VC Address *
Mailing Address
VC City *
City
VC ST *
State
VC Zip *
Zip Code
VC Mobile *
VC E-mail
Vice-Chair E-mail Address
LBA Secretary
Do you have an LBA Secretary? *

Yes No
LBA Sec Name

First Name Last Name
LBA Sec Address
Mailing Address
LBA Sec City
City
LBA Sec ST
State
LBA Sec Zip
Zip Code
LBA Sec Mobile
LBA Sec E-mail
LBA Secretary E-mail Address
Church Treasurer
Do you have a Church Treasurer? *

Yes No
Treas Name

First Name Last Name
Treas Address
Mailing Address
Treas City
City
Treas ST
State
Treas Zip
Zip Code
Treas Mobile
Treas E-mail
Additional Church Officers

Update Information
Have you already updated additional Church Officers (Sunday School Superintendent, Director of Youth Ministry, Director of Children's Ministry, Church Trustees, LBA Members-At-Large, etc.) contact information via the Pastor Portal? *

Yes No
Sunday School Superintendent

or Spiritual Formation Director
SS Supt Name

First Name Last Name
SS Supt Address
Mailing Address
SS Supt City
City
SS Supt ST
State
SS Supt Zip
Zip Code
SS Supt Mobile
SS Supt E-mail
Director of Youth Ministry

or Student Ministries
Youth Leader

First Name Last Name
YL Address
Mailing Address
YL City
City
YL ST
State
YL Zip
Zip Code
YL Mobile
YL E-mail
Director of Children's Ministry

or Local KidMin / Next Gen
Children's Leader

First Name Last Name
CL Address
Mailing Address
CL City
City
CL ST
State
CL Zip
Zip Code
CL Mobile
CL E-mail
Church Trustees

Contact Information
How many Church Trustees do you have?

1 2 3 4 5
Trustee1 Name

First Name Last Name
Trustee1 Address
Mailing Address
Trustee1 City
City
Trustee1 ST
State
Trustee1 Zip
Zip Code
Trustee1 Mobile
Trustee1 E-mail
Trustee1 Term Expires
Trustee2 Name

First Name Last Name
Trustee2 Term Expires
Trustee2 Address
Mailing Address
Trustee2 City
City
Trustee2 ST
State
Trustee2 Zip
Zip Code
Trustee2 Mobile
Trustee2 E-mail
Trustee3 Name

First Name Last Name
Trustee3 Term Expires
Trustee3 Address
Mailing Address
Trustee3 City
City
Trustee3 ST
State
Trustee3 Zip
Zip Code
Trustee3 Mobile
Trustee3 E-mail
Trustee4 Name

First Name Last Name
Trustee4 Term Expires
Trustee4 Address
Mailing Address
Trustee4 City
City
Trustee4 ST
State
Trustee4 Zip
Zip Code
Trustee4 Mobile
Trustee4 E-mail
Trustee5 Name

First Name Last Name
Trustee5 Term Expires
Trustee5 Address
Mailing Address
Trustee5 City
City
Trustee5 ST
State
Trustee5 Zip
Zip Code
Trustee5 Mobile
Trustee5 E-mail
LBA Members-At-Large

Other Board Members Not Listed Above As Officers
LBA1 Name

First Name Last Name
LBA1 Address
Mailing Address
LBA1 City
City
LBA1 ST
State
LBA1 Zip
Zip Code
LBA1 Mobile
LBA1 E-mail
LBA2 Name

First Name Last Name
LBA2 Address
Mailing Address
LBA2 City
City
LBA2 ST
State
LBA2 Zip
Zip Code
LBA2 Mobile
LBA2 E-mail
LBA3 Name

First Name Last Name
LBA3 Address
Mailing Address
LBA3 City
City
LBA1 ST
State
LBA3 Zip
Zip Code
LBA3 Mobile
LBA3 E-mail
LBA4 Name

First Name Last Name
LBA4 Address
Mailing Address
LBA4 City
City
LBA4 ST
State
LBA4 Zip
Zip Code
LBA4 Mobile
LBA4 E-mail
LBA5 Name

First Name Last Name
LBA5 Address
Mailing Address
LBA5 City
City
LBA5 ST
State
LBA5 Zip
Zip Code
LBA5 Mobile
LBA5 E-mail
District Conference Lay Delegates
Have you already updated District Conference Lay Delegates contact information via the Pastor Portal? *

Yes No
How many Delegates were you allotted?

1 2 3 4
NOTE: If unsure, please contact Dist Office Admin Tim Linick.
Del1 Name

First Name Last Name
Del1 Address
Mailing Address
Del1 City
City
Del1 ST
State
Del1 Zip
Zip Code
Del1 Mobile
Del1 E-mail
Vice-Chair E-mail Address
Del2 Name

First Name Last Name
Del2 Address
Mailing Address
Del2 City
City
Del2 ST
State
Del2 Zip
Zip Code
Del2 Mobile
Del2 E-mail
Vice-Chair E-mail Address
Del3 Name

First Name Last Name
Del3 Address
Mailing Address
Del3 City
City
Del3 ST
State
Del3 Zip
Zip Code
Del3 Mobile
Del3 E-mail
Vice-Chair E-mail Address
Del4 Name

First Name Last Name
Del4 Address
Mailing Address
Del4 City
City
Del4 ST
State
Del4 Zip
Zip Code
Del4 Mobile
Del4 E-mail
Vice-Chair E-mail Address
Alternate Lay Delegates
Alt1 Name

First Name Last Name
Alt2 Name

First Name Last Name
Alt3 Name

First Name Last Name
Alt4 Name

First Name Last Name
Candidates for District Leadership

Local Lay Leaders you would suggest to serve in District Leadership
Suggested Leaders
Nehemiah Award Nominations

Please list below any local members/attendees that you would like to see honored as a recipient of the yearly District “Nehemiah Award for Excellence in Lay Ministry” (see criteria below) and GIVE A BRIEF DESCRIPTION of how they have been a Nehemiah in your church.
Must Include Criteria Below...

Criteria: Attendees of local churches who exhibit the following characteristics:1. They care enough about the local church and ministry to get involved and do what they can to meet the challenges of the day. 2. They keep their focus on God. 3. They refuse to give up and keep laboring even through frustrations, discouragement, and increasing obstacles. 4. They are balanced in their desire to build the church and defend against the enemy and his desire to destroy.
Nominee(s) / Brief Description...
Members Promoted to Heaven

From May 1 to April 30
Memb1 Name

First Name Last Name
Memb1 Birth

- Month - Day Year
Date
Memb1 Death

- Month - Day Year
Date
Memb2 Name

First Name Last Name
Memb2 Birth

- Month - Day Year
Date
Memb2 Death

- Month - Day Year
Date
Memb3 Name

First Name Last Name
Memb3 Birth

- Month - Day Year
Date
Memb3 Death

- Month - Day Year
Date
Memb4 Name

First Name Last Name
Memb4 Birth

- Month - Day Year
Date
Memb4 Death

- Month - Day Year
Date
Congrats! You are almost done!

Please check over each entry to make sure all of the submitted information is correct. Some of this information will be published in the District Conference Journal and available in the Pastor Portal, so it is vitally important that the information is accurate! Submit when ready. Thanks so much!
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm