2026 Clergy Move Intake Form

2026 Clergy Move Intake Form
Please complete this form to determine if you are eligible for a move stipend, mileage and per diem reimbursements, or supplemental grants (if applicable). Do not use this form to submit receipts for reimbursement.

If you have any questions about this form, please contact the District Administrator of your receiving district.
Clergy name*

First NameLast Name
Personal Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email*
example@example.com
Current Conference Relationship*
Type of Appointment Change*
YesNo
YesNo
If this is a clergy couple move, what is your spouse's name?

First NameLast Name
Clergy moving from Active to Retired
YesNo
Current District
For clergy moving from Active to Retired, what is the retirement effective date?

MonthDayYear
Retirement Effective Date (MM-DD-YYYY)
For clergy moving from Active to Retired, in which charge conference will your membership be held?
If I am eligible, I understand that I must complete my retirement move within 60 days of my retirement effective date in order to receive reimbursement or have my moving expenses covered.
Current Appointment Information
Current Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OwnRent/LeaseParsonage
YesNo
New Appointment Information
YesNo
One local churchMore than one local churchLocal church and an extensionConference staff
Total Percentage of Appointment to the local church/charge
What is the percentage of appointment to the Extension?
Name of the Extension (if not Conference Staff)
Receiving District
If you are serving more than one church and they are in different districts, please choose the district of the primary church.
Receiving Church(es)
Please list all of the churches in the charge.
If you are serving more than one church, please enter the address of the primary church in the charge.

If you are serving a church and an extension, please enter the address of the church.
Receiving Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Time and Miles Condition (complete only if applicable)
Own/Rent/Lease Current Residence
This section only applies to clergy who currently live in a residence they own/rent/lease and the new appointment does not offer a parsonage.

To be eligible for move benefits, the new appointment needs to be greater than 25 miles from your current residence, OR driving time to the appointment is regularly more than 60 minutes.
If you currently live in a home that you own/rent/lease and your new appointment does not offer a parsonage, what is the one-way distance (in miles) between your current residence and the new appointment?
If you currently live in a home that you own/rent/lease and your new appointment does not offer a parsonage, how long is your average one-way commute (in minutes) between your residence and the new appointment?
Move Details
Move Date ( if known)

MonthDayYear
Date
Moving CompanySelf-MoveNot yet determined
Signature and Submission Information
DA or Move Coordinator Email
example@example.com
If you are not ready to submit this form for approval, click the "Save and Continue Later" button. PLEASE NOTE: You will get an email confirmation with a link to edit the form. Please use that link to open this partially completed form for editing.

When you are ready to submit the form, please check the box below to display the "Submit Intake Form for Approval" button. Sign the form before submitting it for approval. Once you submit the form, it cannot be edited.

When your form has been reviewed, you will get an email with next steps. If you have any questions, please reach out to your receiving District office.
I am ready to submit this form for eligibility review. I understand that I cannot edit this form once it has been submitted.
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2026 Clergy Move Intake Form

Clergy moving from Active to Retired

Current Appointment Information

New Appointment Information

Time and Miles Condition (complete only if applicable)

Move Details

Signature and Submission Information