SYNOD IDENTIFICATION ROLE FORM

THE COMMITTEE ON REPRESENTATION (COR) WOULD LIKE ALL SYNOD MEETING ATTENDEES TO COMPLETE THE SYNOD ID ROLE FORM. THE INFORMATION SUBMITTED HELPS THEM TO ENSURE DIVERSITY OF REPRESENTATION. PLEASE CONTACT LISA LOVELADY, LISA@SYNODSA.ORG WITH ANY QUESTIONS.

SYNOD POSITION*

COMMISSIONER
PRESBYTERY STAFF
SYNOD STAFF
ALTERNATE
OTHER

GENDER*

MALE
FEMALE
OTHER

SYNOD ROLE*

RULING ELDER
TEACHING ELDER
OTHER

AGE RANGE*

25
26–35
36–45
46–55
56–64
65–74
75 or >

ETHNICITY*

AMERICAN INDIAN
MIDDLE EASTERN/NORTH AFRICAN
AFRICAN/AFRICAN AMERICAN
PACIFIC ISLANDER/ASIAN
HISPANIC/LATIN
MULTI-RACIAL
WHITE/EUROPEAN AMERICAN
OTHER

DISABILITY AND ACCESSIBILITY*

DISABILITY WITH ACCOMMODATIONS
DISABILITY WITH NO ACCOMMODATIONS
NO DISABILITY

THIS CATEGORY INCLUDES SYNOD ASSISTANCE FOR SPECIAL DIETS, HANDICAPPED ROOMS, VISUAL/HEARING NEEDS, ELEVATOR NEEDS, ETC.

PRIMARY LANGUAGE, PREFERRED*

ADDITIONAL LANGUAGES

PLEASE LIST ANY OTHER LANGUAGE YOU SPEAK WITH SOME PROFICIENCY

NAME

YOU MAY LIST YOUR NAME IF YOU WISH

EMAIL

YOU MAY LIST YOUR EMAIL IF YOU WISH

SYNOD IDENTIFICATION ROLE FORM

Event Details

SYNOD IDENTIFICATION ROLE FORM