Board of Chaplaincy Certification Inc. (BCCI)

All BCCI certified chaplains are asked to complete this form each year, or as needed if there is a change since the last year.

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* 1. Please enter your APC member ID number.

This can be found by logging into www.professionalchaplains.org, which will take you to your "My Profile" page. Scroll down, and you will find your Member ID below your name and member type.

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* 2.

Please read carefully and complete Section I or II and Section III.

Section I:  I certify that since the completion of my last Accountability for Ethical Conduct form (a) no complaint against me for unethical conduct has been filed, is pending, or has been settled in a civil, criminal, ecclesiastical, employment or another professional organization’s forum; and (b) I have never resigned, been terminated nor negotiated a settlement from a position for reasons related to unethical conduct.

By typing my full name below, I attest that this statement is true.

Section II:  If the above cannot be certified, provide an account of the complaint including the forum, charges, and final outcome. This must be completed using the printable accountability form. Please save the form to your computer, complete and mail the form to the BCCI national office in a sealed envelope marked "accountability statement - confidential."

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* 3.

Please read carefully and complete Section III.

Section III:  I understand that as a condition of certification by BCCI and membership in the Association of Professional Chaplains, I will provide to the association timely notice of any complaint of unethical conduct filed against me (APC Code of Ethics, Standard 130.34). I agree to provide to the APC Commission on Professional Ethics in a timely fashion the information it requests regarding the investigation, adjudication, dismissal or settlement of such complaint. Failure to report or provide accurate, full and truthful information may be grounds for discipline including removal of membership in the Association of Professional Chaplains and removal of BCCI certification.

By typing my full name below, I attest that this statement is true.

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