Clergy Incardination Info

This form is for the use of clergy who have been approved for incardination into the Continuing Evangelical Episcopal Communion and have been asked to provide their personal details.

Reason for Submission Incardination


PERSONAL DATA

Salutation–None–Mr. Ms. Mrs. Dr. Deacon Rev. Rev. Fr. Rev. Dr. Canon Bishop Rt. Rev. Dr. Archbishop Most Rev. Dr. Prof. Ven. Ven Dr. Very Rev. Pastor Bishop Elect
First Name
Last Name
Title

Email
Church Phone
Mobile Phone
Jurisdiction
Street
City
State/Province
Zip
Country
Ministry Website
Baptism Information:
Confirmation Information:


FAMILY INFO

Ever Married ?:–Select Answer–No Yes
Spouse’s Name:
Date of Marriage:

If Divorced, Date of Divorce:
If remarried, date of remarriage:

Deacon Date:
Deacon Officiant:
Priest Date:
Priest Officiant:
Episcopal Date:
Episcopal Chief Consecrator:


ETHICAL and PSYCHOLOGICAL INFO

Note: This section covers criminal history, drug and/or alcohol use and mental health. Please answer all questions.

Have you ever been convicted of a felony?:–Select Answer–No Yes

Have you ever been involved in the illegal possession, use, purchase, manufacture, trafficking, production, or sale of any controlled substance, narcotic, depressant, stimulant, hallucinogen, or cannabis?:–Select Answer–No Yes

Has your use of alcoholic beverages [such as beer, wine, liquor] ever resulted in the loss of a job, disciplinary action, arrest by police, or any alcohol-related treatment or counseling such as for alcohol abuse or alcoholism?:–Select Answer–No Yes

Have you ever been treated for mental, emotional, psychological, or personality disorder/condition or problem?:–Select Answer–No Yes

Have you ever been advised to seek counseling from or been counseled by any mental health professional?:–Select Answer–No Yes