Annual Rostered / Authorized Leader Report Rostered / Authorized Leader Report Annual report to the Bishop What is your current status?Under Call / ContractNot Under Call / ContractOn Leave / DisabilityRetiredDo you wish to discuss the possibility of a change of call? No Yes Is your request urgent? Yes No Title / RoleThe Rev.The Rev. Dr.DeaconDeaconessSAWLDiaconal MinisterOtherName* First Last Has your contact information changed in the past year?* No Yes Date of Retirement (if began in the last year) MM slash DD slash YYYY Home PhoneCell PhonePreferred Email* This email address is:PersonalWorkOtherMailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code At least one of these things has changed in your life the last year:Check all that apply. You got married. You got divorced. You had a baby. You adopted (a) child/children. Other (please explain below) Name of Spouse First Last Date of Marriage MM slash DD slash YYYY Date of Divorce MM slash DD slash YYYY Please list their full name(s), relationship to you, and date(s) of birth:Other life change(s):Life and MinistryName and Location of congregation / ministry site of which you serve / are a member:* Please note any concerns / issues you desire to share with your bishop.As you reflect upon the past year, what were the most significant developments, events, and accomplishments in your life and/or ministry?What challenges do you face now that you are retired?Additional comments:Continuing EducationThe ELCA strongly encourages all rostered ministers and authorized leaders to participate in Healthy Boundaries training at least once every three years and Anti-Racism training at least once every four years.Did you attend Healthy Boundaries training in the past year?* Yes No Did you attend Anti-Racism training in the past year?* Yes No In the past year, you attended... Other continuing education and/or synodical events (list below) No continuing education or synodical events What additional continuing education / synodical events did you attend?*What was your greatest learning / take-away from that education?*Additional comments:Compensation and BenefitsThis personal information is not shared but used to help synod staff be aware of actual compensation patterns in the synod.Your call is: Full time Part time Last year's Base Salary:Last year's Housing allowance (above base salary)If not provided, just type in the number 0.Other Compensation / Reimbursements for the past yearLast year's Continuing Education allowanceLast year's ELCA Portico Benefits - Pension: 10% 11% 12% Last year's ELCA Portico Benefits - Medical and Dental: Member Spouse Dependents Coverage Waived (Check all that apply)Last year's ELCA Portico Benefits Level: Silver Gold Platinum Δ