Change in Clergy Relationship (Form 106)

Application for Change in Clergy Relationship to the Annual Conference

Form 106 for the Baltimore-Washington and Peninsula-Delaware Area.
This form automatically notifies your DS, BOOM Chair, CRC Chair, and the Episcopal Office upon submission.

Before you begin, have you:
- Read the relevant paragraph in the Book of Discipline to understand the process, documentation, and other requirements of your request? The BOD references are indicated below, next to each status.
- Had a conversation with your District Superintendent?
- Had a conversation with the Benefits Office so that you understand the impact of your status change on your pension and benefits?
If you have answered no to any of these items, please complete them before submitting this form. Thank you!

If you have any questions, concerns, or technical issues with this form, please contact bomstaff@pdcbwc.org.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone Number*
Email*
Current Clergy Relationship to BWC and PDC Area*
If you are unsure, please contact your District Office before submitting this form.
Current Appointment*
Please share the name of the church or organization where you are serving.
Conference / Denomination*
If "other," please indicate other Conference or other denomination in the next question.
Name of Other Conference or Denomination
District*
If "other," please indicate other District or region/diocese in the next question.
Name of Other Conference District or Denominational Region/Diocese
Licensed Local Pastors and Associate Members
I hereby request the following change in my relationship to the annual conference:

Discontinuance as a Licensed Local Pastor (¶320.1)End appointment but remain approved but not appointed (An annual interview with the DCOM is still required to maintain certification and licensing credentials)Appointment on-loan to another Annual Conference (¶318.4)Appointment to Extension Ministry (¶344.1)Retirement (¶320.5) - indicate Category of Retirement below
Provisional Deacons and Elders
I hereby request the following change in my relationship to the annual conference:

Discontinuance as a Provisional Member (¶327.6)Appointment to Less than Full-Time Service (¶338.2)Appointment to Extension Ministry (¶344.1)Transfer (¶347)Sabbatical Leave (¶352)Voluntary Leave of Absence - Personal (¶354.2a)Voluntary Leave of Absence - Family (¶354.2b)Transitional Leave of Absence (Deacon) (¶354.2c (1))Transitional Leave of Absence (Elder) (¶354.2c (2))Returning to Active Status (¶354.11)Maternity/Paternity Leave (¶356)Medical Leave (¶357)
Full Deacons and Elders
I hereby request the following change in my relationship to the annual conference:

Appointment Site Approval - Extension Ministry or Local Church (Deacon) (¶331.4)Appointment to Less than Full-Time Service (¶338.2)Appointment to Extension Ministry (¶344.1)Affiliate Membership Request (¶344.4)Transfer (¶346)Sabbatical Leave (¶352)Voluntary Leave of Absence - Personal (¶354.2a)Voluntary Leave of Absence - Family (¶354.2b)Transitional Leave of Absence (Deacon) (¶354.2c (1))Transitional Leave of Absence (Elder) (¶354.2c (2))Returning to Active Status (¶354.11)Maternity/Paternity Leave (¶356)Medical Leave (¶357)Retirement (¶358) - indicate Category of Retirement belowHonorable Location (¶359)Withdrawal to Unite with Another Denomination (¶361.1)Withdrawal from the Ordained Ministerial Office (¶361.2)Withdrawal Under Complaints or Charges (¶361.3)
Category of Retirement
My category of retirement is:*

Mandatory Retirement at Age 72 (¶358.1)With 20 Years of Service (¶358.2a)With 30 Years of Service or at Age 62 (¶358.2b)With 40 Years of Services or at Age 65 (¶358.2c)Full-Time Local Pastor (¶320.5)Part-Time Local Pastor (¶320.5)
New Charge Conference:*
If you have not yet identified a Charge Conference, please indicate "in process."
New District:*
If you have not yet identified a Charge Conference, please indicate "in process."
Requested Effective Date of Clergy Relationship Change*

MonthDayYear
For most requests, this date will be July 1.
Click "Browse Files" to upload PDFs or Word Docs of your Written Request and/or Required Supporting Documentation*

Please consult the Book of Discipline paragraph relevant to your request for requirements around written requests and supporting documents.
Cancelof
Today's Date*

MonthDayYear
Your Signature*
Type your full legal name here.
First Name*
Middle Name
Last Name*
Should be Empty:

Application for Change in Clergy Relationship to the Annual Conference

Licensed Local Pastors and Associate Members

Provisional Deacons and Elders

Full Deacons and Elders

Category of Retirement