Nominations Form

Biographical Form - General Use

TO BE COMPLETED BY THE POSSIBLE NOMINEE
*(indicates required data)

*To be considered for

*Specify which Board or Churchwide Committee

1.* Please provide full, legal name

NOTE: TO SATISFY ELCA CONSTITUTIONAL REQUIREMENTS ON NOMINATIONS,
THE FOLLOWING SECTION MUST BE COMPLETED.
FAILURE TO DO SO WILL PRECLUDE CONSIDERATION OF NOMINATION.

A. Gender: B. *Birthdate: C. *Primary language English:

Gender Other:

D. *Ethnic/Racial Group

E. *Are you a rostered minister?
Yes No

If yes, provide your Leader Key:

If yes, by which synod:

F. *Are you willing to serve, if elected?
Yes No
G. *Are you related to an ELCA churchwide staff member?

Yes No

If yes, print name here:

If yes, by what relationship:

H. *If you are a nominee for the Board of Pensions (Portico Benefit Services),

are you a member or potential recipient of benefits in any form of the pension plan? Yes No

2.* Preferred Mailing Address
* Address

Unit Number
* Type

*City * State * ZIP Code -
*Country

3. Residence: If different from preferred mailing address

Address Unit Number

City State Zip Code -
Country

4.* Preferred Telephone: (Alternate)

5.* E-mail: Type (Confirmation will be sent to the e-mail address above.)

6.* Are you a member of an ELCA Congregation ?
Yes No

Congregation name (partial) : State :
Congregation Membership :
Select a Congregation by clicking SEARCH
Tip: Enter one word from the congregation's name (ex. Paul for St Paul Lutheran Church) and the state abbreviation before clicking "Search."

7. Educational Institutions:

a. from to Degree

b. from to Degree

c. from to Degree

8. Employer
* Name (current or most recent)
* City * State * Start Date
End Date
* Position/Title : Date retired (if applicable)

Previous Employment: a. from to

b. from to

9.* List current or past congregation, synod or churchwide service activities: (include the year of service)
a. from to

b. from to

c. from to

10.* Briefly describe your sense of God calling you into mission and service in the Evangelical Lutheran Church in America through the work of this board or committee. What are the gifts, skills, experiences and areas of expertise that you would bring to this work? (1000 characters max, 1000 characters remaining ...)

11. If you are not nominated to serve on the board or committee for which you have applied, would you consider serving on another? If so, which one(s) ?

12. Please give us the name of someone who can speak to your skills and attributes related to your previous congregation, synod or churchwide service activities:

What is your relationship to this person?

4/24/2024
(If desired, please print form before submitting.)

*To be considered for

This is Christ's church.

There is a place for you here.