License to Officiate (LTO) Report & Renewal Request Form

If you wish to renew your license, please complete and submit this form. In the Diocese of New York licenses are in effect from July 1st – June 30^th, the report and renewal process takes place annually in June/July.

Questions? Contact Alito Orsini (aorsini@dioceseny.org), Liaison for Transition Ministry.

LTO Report & Renewal Form

Your title * Your title

First name *

Last name *

Contact Info

Phone 1 *

Phone 2

Email 1 (Confirmation will be sent to this address) *

Email 2

Address Line 1 *

Address Line 2

City *

State *

Zip *

Canonical Residence

Name of Your Diocese *

Name of Your Bishop *

Do you hold other Licenses to Officiate? *

Yes

In which diocese(s) do you hold it/them?

Are you? (You may select more than one option or leave all blank.)

Employed Full Time

Employed Part Time

Engaged on a Non-Stipendiary Basis

Please Provide Details of Your Place(s) of Employment/Non-Stipendiary Engagement

Name of church/institution *

Address of church/institution *

Your position *

Add another place of employment Remove

Are You Retired?

Yes

Year of retirement * Year of retirement

Please provide details of the churches and dates when you have provided supply over the last twelve months (July 1 to June 30).

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add another?

Yes

No, I'm finished.

Supply Instance 2

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add another?

Yes

No, I'm finished.

Supply Instance 3

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add another?

Yes

No, I'm finished.

Supply Instance 4

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add another?

Yes

No, I'm finished.

Supply Instance 5

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add another?

Yes

No, I'm finished.

Supply Instance 6

Name & Location of Church Name & Location of Church

If you don't see it, please scroll to the bottom, select "Other," and fill out the box.

Date(s) of Supply Work

Add more?

Yes

No, I'm finished.

If you provided supply at more than six churches between July 2015 and June 2016, please provide details in the box below.

When you are finished, please check the box below to prove you are not a spam machine, then click on "Submit."

Form submission problems? Please scroll up to ensure that all required fields are properly completed.

Transition Office Contacts

The Rev. Canon Nora Smith

Canon for Transition Ministry, Intake Officer

Cell: 917-319-3959
Office: 212-316-7421
nsmith@dioceseny.org

Mr. Alito Orsini

Liaison to Canon for Ministry, Liaison to Canon for Transition Ministry

Office: 212-316-7414
Fax: 212-932-7368
aorsini@dioceseny.org