Summary Report Action Outline SRAO04 LP: Continuance recommendation Name:
______________________________________________________________________ DCOM Registrar
District:
[__] AP [__] CM [__] NR [__] SS [__] SM [__] TV
Note:
On this form you will list all Persons for which a vote is taken and place the date of the vote in the appropriate column.
Discontinuance Codes: FT – for transfer to another annual conference FP – for failure to progress in COS OC – other cause/reason as determined by DCOM/DS
Local Pastor Last
First
Sample
Pastor
Date of Vote: Continuance Discontinuance Date Date Code
Please submit copies of this form to: [__] DCOM file [__] The Office of Clergy Services via DCOMConcerns@holston.org
2023-10-01
OC
Effective Date 2024-01-01
Updated: 2025-08