Teaching Parish Information Form

Please note: Students with a Teaching Parish Placement will need to register for Teaching Parish in Opus. (This form does not register you.)

Student Name*

First Name

Last Name

Emory Email*

Cell Phone*

7 Digit Student Emory ID Number

Preferred Pronouns

Date of Birth*

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Denomination*

If serving as an Assistant or Associate Pastor enter the Senior Pastors Name Below:

If serving as an Assistant or Associate Pastor enter the Senior Pastors Email Below: -

Church Information

Church(es) or Campus Minstry Name(s)*

Church City and State*

Church Phone*

Position at Church or Campus Ministry*

Appointment District - UMC Only

Appointment Annual Conference - UMC Only

Appointment District Superintendent Name - UMC Only

Appointment District Superintendent Email - UMC Only

Appointment District Superintendent Phone - UMC Only

Head of Judicatory or Board

Employer Name

Employer Email

Employer Phone

Home Annual Conference

Home District

Home District Superintendent Name

Home Superintendent Phone

Home Superintendent Email

Certified Candidate for Ordained Ministry?

Yes No

Approved as Local Pastor?

Yes No