Report of Clergy Licensed to Serve 2025

First Name

Do you have the same address as last year?

Last Name

Diocese of Canonical Residence

If applicable, what is your new address?

Street Address

Address Line 2

City

ZIP / Postal Code

State / Province / Region

Country

Please include your preferred telephone number and email address below, even if they have not changed this year.

Phone

Part 2

Did you exercise your ordained ministry in this diocese during the year stated above?

Do you wish to renew your license to serve in the Diocese of East Carolina for another year?

If you live in East Carolina, do you wish to have your name included on the Supply Clergy list made available to all parishes?

Part 3

During the year stated above, I was called to serve regularly in the following congregation(s) or church related positions (chaplaincy, diocesan staff, mission, etc.) and all Ecclesiastical Acts which I performed are recorded in their register. To add additional congregations, click the blue + icon.

Congregation

Location

Part 4

Please list all Ecclesiastical Acts which you performed in this diocese, besides those performed in a congregation or church related position where you were called to serve. To add additional acts, click the blue + icon.

Ecclesial Act (whether recorded or not recorded)

Congregation

City, State

Date (Month, Year)

Signature

Date

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