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BACE Part 1 Application

Black Addiction Counselor Education

After a potential participant submits the Part 1 Application and Part 2 (two (2) letters of recommendation), an appointment will be scheduled with the Program Director. Acceptance decisions are made on an individual basis. As soon as decisions are made, candidates will be notified in writing.

Please use the form below to submit your two professional letters of recommendation to the program.

Online applications are preferred. Please contact Della Blake, BACE Program Director at drblake@bace-aei.org if you need to submit a paper application.

The 2019 class is currently meeting, and 2020 classes in Boston and Springfield will begin in the fall of 2020.

If you are interested in applying for the next program, use this form.

Due to demand and a growing waiting list, there is limited space for this program. The program will give priority to individuals who submit complete applications with letters of reference promptly.

1. Personal Information

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* First Name:

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* Last Name:

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* Are you applying for the Boston, MA class or the Springfield, MA class?

Boston

Springfield

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* How did you learn about this program? *

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* Address Line 1

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* Address Line 2

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* City

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* State

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* Zip code

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* Phone

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* Email

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* Alternate email

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* Age

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* Gender

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* National/Ethnicity (please be specific):

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* What language(s) do you speak?

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* Are you in recovery from a substance use disorder or mental health disorder (i.e. cocaine, compulsive gambling, depression)?

Yes

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* If you answered YES, please specify length of time in recovery:

2. Employment Information

If Applicable

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* Agency Name

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* Position / Title

Work Address

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* Address Line 1

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* Address Line 2

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* City

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* State

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* Zip Code

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* Work Phone

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* Work Email

3. Education Information

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* Please check all applicable information about your education:

High School Graduate

Completed Hi-Set/GED

Currently enrolled in High School, Hi-Set/Ged

Completed Undergraduate School

Currently enrolled in Undergraduate School

Completed Graduate School

Currently enrolled in Graduate School

Completed Doctoral School

Currently Enrolled in Doctoral School

4. Employment History

Please list all positions you have held in the past, including part-time, OR indicate that a copy of your resume is attached.

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* Please use this button to upload a copy of your resume. Your resume is required.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* I have uploaded a copy of my resume

Yes

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* Employer 1:

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* Employer 1 Address:

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* Start Date at Employer 1:

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* End Date at Employer 1:

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* Position Held at Employer 1:

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* Duties/Responsibilities at Employer 1:

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* Employer 2:

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* Start Date at Employer 2:

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* End Date at Employer 2:

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* Position Held at Employer 2:

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* Duties/Responsibilities at Employer 2:

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* Employer 3:

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* Employer 3 Address:

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* Start Date at Employer 3:

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* End Date at Employer 3:

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* Position Held at Employer 3:

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* Duties/Responsibilities at Employer 2:

5. Previous Training

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* Have you ever received other formal training in substance use disorder or mental health counseling?

Yes

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* If yes, briefly describe training(s) and date(s):

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* 6. Counseling Experience

No Prior Counseling Experience

Individual Counseling - Professional Work

Individual Counseling - Personal Experience

Group Counseling - Professional Work

Group Counseling - Personal Experience

Couples Counseling - Professional Work

Couples Counseling - Personal Experience

Family Counseling - Professional Work

Family Counseling - Personal Experience

Other (Please describe below.)

Other (please specify)

7. Criminal History

Please note: criminal conviction is not automatic grounds for rejection. Please respond for any violations including misdemeanors and/or traffic violations.

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* Have you ever been convicted of a crime?

Yes

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* Are there any pending charges against you currently?

Yes

8. Personal Statement

How do you feel this program will help you to achieve your professional goal(s)? Either use boxes below, or upload a file with your personal statement. (Please limit to no more than 500 words.)

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* Upload Personal Statement File (or use paragraph boxes below to provide personal statement).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* Personal Statement Paragraph 1

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* Personal Statement Paragraph 2

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* Personal Statement Paragraph 3 (if needed):

9. Signatures

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* Required Electronic Signatures

By checking this box, I certify that I have read and understand the program admission requirements and that the information in this application is true and complete to the best of my knowledge.

My signature above hereby affirms that the information set forth in this application is complete, accurate and true to the best of my knowledge. I further affirm that I have completed the application and have not withheld any information or response to any questions. I understand and agree that any misrepresentation or omission of facts on this application or during the interview process, regardless of when discovered, may result in the refusal of admittance to the program, or if I have already been admitted to the program, will constitute cause for my immediate dismissal.

Be sure to click on "Submit" button below.