App 13 Application: Request to Continue Previously Approved Voluntary Leave of Absence (VLOA) Status Name:
______________________________________________________________________
Address:
______________________________________________________________________
First
Middle
Street
City
Best Contact # (______)________-__________ [__] Cell [__] Home [__] Work Email: Clergy Status: District: Charge:
Last
Birthdate:
State
_________ _________ __________ Month
Day
Year
______________________________________________________________________ [__] Full Elder [__] Full Deacon [__] Provisional Member [__] Associate Member [__] AP [__] CM [__] NR [__] SS [__] SM [__] TV ______________________________________________________________________
Having been previously approved, I would like to request that I remain on: Date original VLOA became effective:
Please note:
Zip
[__] Personal LOA [__] Family LOA
_________ _________ __________ Month Day Year
Failure to request annual extension via submission of this Application may invoke the Action of the 2020/2024 Book of Discipline ¶354.12 and result in your being placed on administrative location (¶360).
(Please remember that this request should be submitted by January 1st of each calendar year.) __________________________ Signature
_________________________ Printed Name
___________________ Date
Office Use: Date BOMEC/BOM approved request: _________ _________ __________ Month Day Year Annual Conference Clergy Session __________ [__] did / [__] did not approve this request. AC Year Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org [__] DCOM 1 of 1
Updated: 2025-07