Mid-South Conference Council Or As a Synod Delegate

Please use this form to self-nominate or identify potential candidates for positions on OurMissouri

Mid-South Conference Council or as a Synod Delegate.

OurConference is seeking a highly qualified, diverse pool of candidates for a limited number of Conference Council and Synod Delegate positions. Members shall be selected so the bodyrepresents diverse population groups and can bring to its deliberations a variety of points of view and life experiences, as well as access to cultural, religious, educational, civic, and economic resources.

Candidates for ourConference Council must meet the following criteria:

• Be a member of a congregation in the Missouri Mid-South United Church of Christ Conference.
• Understands and accepts the conference’s philosophy and position on organizational diversity.
• Understands and accepts the conference council’s obligation to abide by the policies of the conference.
• Regularly attends and participates in counciland committee meetings.
• Understands the necessity for, and keeps the confidentiality of, the council’s work until such time as it is released for public information.
• Abstains from any actions that might lead to a conflict of interest.

Candidates not selected for council membership or Synod delegate may be referred for other positions.

PLEASE TYPE OR PRINT CLEARLY. Attach a resume or other relevant biographical information.

Send completed form by MARCH 31, 2017to:

Missouri Mid-South Conference UCC

Attn: Leadership Development Committee Chair

483 E. Lockwood Avenue, Suite 15

St. Louis, MO63119

OR Email: OR Fax: 314-918-2610

CIRCLE ONE: Prospectfor CONFERENCE COUNCIL or SYNOD DELEGATE

Name of Prospect

Home Address

City

State

Zip

Email

Church Affiliation/City

Occupation (please also indicate if ordained/licensed/certified)

Business Name/Address

City

State

Zip

Ethnicity

Gender

01/2016 MMSUCC Conference Council PROSPECT form

Briefly describe the gifts this prospect offers, highlighting no more than three areas of greatest strength.

If applicable, please describe this prospect’s church, association or Conference experience and participation, both current and past.

Please describe this prospect’s experience or work in:

Local State National International

______

Please indicate this prospect's experience or work in:

ATTACH A RESUME or other biographical information summarizing prospect’s experience and education.

REFERRAL:

Signature

Date

Day-time phone

E-mail

Address

City

State

Zip

Position in Conference or association, if any

In an effort to maintain the diversity of ourConference, please consider voluntarily disclosing any of the following information:

FOR COMMITTEE USE:

RECEIPT Date: ______By: ______

Notes:

01/2016 MMSUCC Conference Council PROSPECT form