ga 221 2014 application

Presbytery of Scioto ValleyAPPLICATION FOR NOMINATION TO THE 221st GENERAL ASSEMBLY (2014)

June 14-21, 2014 – COBO Center, Detroit, Michigan

Check the position you are applying for:Check the position you are applying for:Check the position you are applying for:Check the position you are applying for:Check the position you are applying for:Check the position you are applying for:

Teaching Elder Commissioner Ruling Elder Commissioner Young Adult Advisory Delegate

Name Cell PhoneCell PhoneStreet Address Work PhoneWork Phone

Home PhoneHome PhoneCity, State, ZIP Email AddressEmail Address

Church of Membership or Pastoral ServiceChurch of Membership or Pastoral ServiceChurch of Membership or Pastoral ServiceChurch of Membership or Pastoral ServiceOrdination Year (Teaching and Ruling Elders)Ordination Year (Teaching and Ruling Elders)Ordination Year (Teaching and Ruling Elders)Ordination Year (Teaching and Ruling Elders)

Year of Previous Service as a G. A. Commissioner (if applicable)Year of Previous Service as a G. A. Commissioner (if applicable)Year of Previous Service as a G. A. Commissioner (if applicable)Year of Previous Service as a G. A. Commissioner (if applicable)Year of Previous Service as a G. A. Commissioner (if applicable)

Which Presbytery? Which Presbytery?

Last Year the Church had a Commissioner (Teaching or Elder) (If Known)Last Year the Church had a Commissioner (Teaching or Elder) (If Known)Last Year the Church had a Commissioner (Teaching or Elder) (If Known)Last Year the Church had a Commissioner (Teaching or Elder) (If Known)Last Year the Church had a Commissioner (Teaching or Elder) (If Known)Last Year the Church had a Commissioner (Teaching or Elder) (If Known)

Young Adult Advisory Delegates:Young Adult Advisory Delegates:Young Adult Advisory Delegates: Year Joined Church Birth DateBirth Date

Check as Appropriate:AGE DISABILITY GENDER MARITAL STATUS RACIAL/ETHNIC

Under 25 Hearing Female Married African American25-35 Mobility Male Single Asian36-55 Sight Widowed/ Divorced Caucasian56-64 Hispanic

Over 65 Native American

To complete the application, please respond to the question on page 2.

SESSION ENDORSEMENT (For Ruling Elder Commissioner and Young Adult Advisory Delegate Nominees)

The Session of took action on to give its endorsement of to give its endorsement of to give its endorsement of

as a Ruling Elder Commissioner / Y.A.A.D.as a Ruling Elder Commissioner / Y.A.A.D.as a Ruling Elder Commissioner / Y.A.A.D.

Clerk of Session NameClerk of Session Name Phone

Email completed application to dagmar@psvonline.org or mail to Presbytery of Scioto Valley, 6230 Busch Blvd., Suite 250, Columbus, OH 43229-1866. Application Deadline is November 1, 2013.

Please describe your service to the local and/or larger church or other qualification to serve as a commissioner or delegate to the General Assembly.