Please use this form to report your monthly CEUs :
(Allow at least 10 minutes to complete the form.)

Name
Phone
Email

Click here if you are exempt from earning CEUs

CEU EVENTS ATTENDED
Note:  10 hours of qualified instruction are required per CEU granted

I have completed the following event(s) under qualified leadership:

(The list of events below by date are approved for credit by Wesley Leadership Institute.  By clicking on one or more events, you will receive credit for the event.  NOTE:  If the event is not listed below, please fax or mail an agenda, brochure, or certificate of CEU's for the event to: Wesley Leadership Institute, P.O. Box 850, Alcoa, TN 37701-0850.)
Select events from the list below. Hold down the "control" key to select more than one event.

STOP! For other events not in the list above, documentation must include one of the following: a certificate of CEUs earned, or a written reflection on a Wesley Leadership Institute Evaluation Form of the Experience, along with a course schedule of the event. Mail or fax this information and/or materials right now. THEN, proceed to other items below. Most programs sponsored by an agency of the General Conference, Jurisdiction, Area, Annual Conference, or District, and accredited ecumenical or community service institution are considered as having qualified leadership, and thus may qualify for the Wesley Leadership Institute to grant CEUs.


OTHER CEU ACTIVITIES
Note:  Most effective adult learning takes place when participants share knowledge.
Therefore,

  • At least 1 CEU should be earned in a group setting.
  • Only 1 CEU will be awarded for personal study, including book, video or audio selections.
  • Only 1 CEU will be awarded for internet learning

A. STUDY GROUP
I have participated in a study group for developing ministry effectiveness, i.e., biblical/theological reflection, Lectionary, etc.  Describe group, how often you met, how often you attended.

Group Name Type of Group Meeting
Frequency		 Total
Hours
Attended

Additional study groups:


B. PERSONAL READING
I have spent at least 20 hours reading the following books in the core curriculum areas:  Wesleyan Theology, Pastoral Care, Worship and the Sacraments, Church organization/ Administration, Evangelism/Outreach, Communication/ Preaching, Leadership, Personal Spiritual Formation, and/or Biblical Studies. 
List Book, Author, Publisher, and Date of Publication
As per CE Guidelines, send a brief outline for each book read.
(Postal Address: Wesley Institute, PO Box 850, Alcoa, TN 37701)

Book Author Publisher Date of
Pub.		 Outline Mailed
Via
email
postal
email
postal
email
postal

Additional books read:


Or, AUDIO/VIDEO TAPE
I have listened or viewed at least 10 hours of audio or videotapes or participated in on-line distance learning which are formational for ministry as listed:

Name of tape/session Author Publisher Date

Additional tapes:


C. TRAVEL STUDY TRIP
Travel Study Trip under qualified leadership with lecture and discussion:  ALL TRAVEL TRIPS MUST BE APPROVED PRIOR TO TRAVEL SO CEU’S CAN BE ESTABLISHED.
List Trip Name, Destination, Sponsor, Dates. If travel study trip is NOT on our course list of events (see above), , please attach by e-mail or mail the following: Course Syllabus, Purpose of Trip, Books Read, Itinerary, Lecturer and Credentials, Itinerary, Study Objectives, and Website Address:





Non-exempt clergy click here to complete and submit form.


I AM Exempt from earning CEUs this year due to one of the following:

Persons under appointment who are actively involved in academic study in this appointment year 2004-05 such as: 
Which type of academic study?
a. Course of Study
b. Advanced Course of Study
c. College degree programs
d. Seminary degree programs

School Attended:
Courses Taken
Dates

Clergy enrolled in an accredited Clinical Pastoral Education program
Name of Program, School, Location, Dates:

Clergy enrolled in Doctor of Ministry work at an accredited seminary
School:
 #  Semester Hours for this appointment year:   
Fall Winter Spr Summer

Probationary Members who are active in the Board of Ordained Ministry’s Mentoring Program. 
Mentor: 


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HOLSTON CONFERENCE CENTER - ALCOA
217 S. Rankin Rd. | Alcoa, TN 37701
PO Box 850 | Alcoa, TN 37701 | Phone (865) 690-4080 | Fax (865) 690-3162
Toll-free outside the Knoxville calling area: 1-866-690-4080
HOLSTON CONFERENCE JOHNSON CITY SATELLITE OFFICES
210 Maple St. | Johnson City, TN 37604
PO Box 2506 | Johnson City, TN 37605 | Phone (423) 928-2156 | Fax (423) 928-880

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