App 10 Application to go on Voluntary Leave of Absence (VLOA) Name:
______________________________________________________________________ First
Address:
Middle
Street
City
Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work Email: Clergy Status: District: Charge:
Last
______________________________________________________________________
Birthdate:
State
Zip
_________ _________ __________ Month
Day
Year
______________________________________________________________________ [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member [__] AP [__] CM [__] NR [__] SS [__] SM [__] TV ______________________________________________________________________
After review ¶353 of the 2016 Book of Discipline, I would like to request: [__] Personal LOA [__] Family LOA [__] Transitional LOA Initial the following: ______ I have attached a written request stating the detailed reasons for my request. ______ I signify that I have read ¶354 of the 2020/2024 Book of Discipline and that I have read the Frequently Asked Questions section that is part of this application document. ______ I further signify that I understand the process and the implications related to my request to enter into a Voluntary Leave of Absence Status with the Holston Annual Conference. I desire for this leave to become effective:
__________________________ Signature
_________ _________ __________ Month Day Year Please remember that this request should be submitted 90 days prior to the above-mentioned date.
_________________________ Printed Name
___________________ Date
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org [__] Current District Superintendent 1 of 1
Updated: 2025-07