Request Directory Listing

Individuals interested in being listed in the UBA Supply/Interim Directory may complete the form below.  Please complete only the information that you wish to be listed publicly. Resumes are posted in a public, unprotected area of the website. Resumes are not required but may be submitted in Word or pdf format to  Listings may be deleted after 6 months in order to ensure current contact information is maintained.

Name: *
First Name
Last Name
Please indicate the directory in which you wish to be listed. *
Mailing Address
Address Line 1
Address Line 2
Postal Code
Primary Telephone Contact # (Day)*
Evening Phone
Cell Phone
Please list languages in which you are fluent.
In what church are you currently active?*
Have you completed an Intentional Interim Certification course?
What professional degrees have you completed?
What seminary degrees have you completed?
Please list the full name of one reference.
Please list the current place of employment and title of your reference.
Please list one or more phone numbers where your reference can be reached*
Have you submitted a resume by separate email to (Submission of a resume constitutes permission to post it publicly on the UBA website.)