pension change of status form

The purpose of this form is to notify the Human Resources office of any changes in your status. These changes include: first-time pastoral appointment, church or conference transfer, discontinued appointment, retirement, leave of absence, housing and/or salary changes, address changes, and marital status changes.

For salary changes, please review the Pastor's Compensation Calculator to make sure you are reporting the correct amounts for pension purposes. 

When you click the "Submit" button, this form will be electronically transmitted to the Human Resources office. Please be sure to notify your conference office of changes in status as well. To print and fill out the form instead, please click on the link below (you may then submit the form by mail or by faxing it to the attention of "Human Resources" at 317-244-1503). 

Please be careful not to hit the "return/enter" button as it may cause the form to be prematurely submitted in some browsers. Use the mouse or the tab key to move between the input boxes.

Change of Status Form - Printable Version

For instructions on filling out this form, click below:

Change of Status Form - Instructions

You need Adobe Acrobat Reader to view the printable form and the instructions.  If you do not have this program, you can download it for free by clicking the button below: 



Name 
Birthdate 
Spouse's Name 
Current Conference Name 
Conference Number 
Current Church Name 
Church Number 
Church Street Address 
City 
State 
Zip Code 
Change Effective Date 
New Conference Name (if changing conferences) 
Conference Number 
New Church Name (if changing churches) 
Church Number 
Church Street Address 
City 
State 
Zip Code 
Type of Change (check all that apply) 
First-time pastoral appointment
Discontinued from pastoral appointment
Change in compensation (salary and/or housing)
Transfer to another conference
Retirement
Leave of absence
Transfer to a new church
Salary (please list even if it has not changed) 
  Week Month Year
Housing (please list even if it has not changed) 
  Week Monthly Year
Other information that would help us better understand your situation 
Email Address (in case we need to contact you) 
Other Contact Information (phone or fax) 
Initials 
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