Clergy Cultural Competency Report Form

All persons under appointment or assignment need to complete a minimum of seven content hours of cultural competency training each quadrennium to be eligible for appointment in the following quadrennium. This may consist of one or more training or study engagements. If the engagements are self-produced, or produced outside of the PNW Conference structure, they must be pre-approved by your district superintendent.

Use the form below to document your courses, training or engagements. If you use two or more engagements to fulfill the seven-hour requirement, you may submit up to two of them on this form. If you use three or more, submit separate forms as you complete the work.

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* 1. Name of Person under Appointment or Assignment

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* 2. Today's Date

Date / Time

Date

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* 3. Current Appointment or Assignment

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* 4. District or Ministry Location

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* 5. Order of Ministry

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* 6. Course/Training/Study Title and Description

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* 7. Name of Primary Presenter

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* 8. Place and Date of Session

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* 9. Number of Content Hours

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. If you lead the study, who participated?

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* 11. Additional Course/Training/Study Title and Description (If none, skip to #16)

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* 12. Name of Primary Presenter

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* 13. Place and Date of Session

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* 14. Number of Content Hours

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 15. If you lead the study, who participated?

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* 16. A Personal Plan of Action is required for self-produced studies. Please indicate the goals of your personal plan of action.

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* 17. Please Type Your Name Representing Your Electronic Signature