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Circuit Elder Contact Report
Contact Information
Circuit Elder Name
*
Circuit Elder Email Address
*
Type of Contact
*
Contact with a pastor
Charge Conference with Congregation
Circuit gathering of the pastors
Congregational Lay Leadership Gathering
Contact with a Lay Church Leader (please identify leader in the report's Question 1 below)
Other
Other
Date of Meeting/Contact
*
+
Supervising DS
*
🛈
Ulysses Washington - Central (CE) Office
Zach Roberts - Northeast (NE) Office
Roy Beth Kelley - Northwest (NW) Office
Dee Dee Autry - South (SO) Office
Name of Church/Charge (if not a circuit-wide meeting)
Name of Pastor (if not a circuit-wide contact/meeting)
Contact Report
1) Describe the Contact
*
2) What next steps are the pastor/congregation going to take?
3) What does the District Superintendent need to know?
Consultation Response
Follow Up Plan:
No follow-up needed
I will be following up with the Pastor
I need a call from the DS about the situation
NOTE: In situations of concern, please complete this form and then immediately
CALL
your district superintendent.
Once you click "submit," your Circuit Shepherd Contact Report will be
emailed to the District Office, with a receipt emailed to you.