The following statements will require your attestation (affirming each one to be true to the best of your knowledge), as well as your signature on the formal Application Form. Please be sure to review each and every section that directly pertains to you and your professional and or ministerial work. You DO NOT need to send this form in; however, the information it contains is important and will be referenced in the actual application. Depending on your responses, additional information may be required in order to process your application.

SECTION A: Christian Personal Testimony

The foundation to all work and identity as a Christian counselor/caregiver is a living, vibrant, and personal relationship with Jesus Christ. Please respond to the following items by considering the appropriate box:

  1.  I have read the AACC Doctrinal Statement and hereby attest that I am in full agreement with its tenets.
      Yes  No  Unsure

  2.  I attest that I am a true believer in Jesus Christ; that I have accepted His atoning work of salvation on the cross for the forgiveness of my sins; that I have personally accepted Him as my Savior and Lord; and that as a result of my confession, I have been born again by His Holy Spirit to a new life in Christ.
      Yes  No  Unsure

    3. If you answered “No” or “Unsure” on any item in this section, please explain your response on a separate page and include with your application (no more than two pages).

SECTION B: Christian Counseling Testimony

The practice of Christian counseling/caregiving genuinely incorporates scriptural truths, biblical principles and guidance, and a Christian value system into one’s clinical/ministerial practice, theoretical orientation, and professional life. The BCPPC is dedicated to credentialing Christian counselors, not simply clinicians and lay helpers who happen to be Christian, but do not incorporate their faith into practice. Please respond to the following items by considering the appropriate box:

  1.  I attest that I actively and consistently – with client consent wherever and whenever it is appropriate – incorporate explicit Christian practices (e.g., prayer, Bible references, Christian service, encouragement in the spiritual disciplines, meditation, spiritual warfare, etc.) into my counseling/ministerial practice and/or environment.
      Yes  No  Unsure
  2. I attest that I have already obtained (prior to the submission of this application to the BCPPC) the required 60 contact hours that incorporates biblical principles and counseling skills with theory, knowledge, and practice for the credential I am seeking.
      Yes  No  Unsure
  3. If you have not completed your contact hours through approved activities or programs, do you have a record of other training you have received or evidence showing publications, programs and/or presentations you have done that you would like the BCPPC Credentials Committee to evaluate as a substitution for this requirement?
      Yes  No  Unsure    (If “Yes,” please include the appropriate documentation.)

    4. If you answered “No” or “Unsure” on item 1 or 2 in this section, please explain your response on a separate page and include with your application (no more than two pages).

    SECTION C: Ethical Integrity

    Each applicant must demonstrate and maintain ethical integrity in all counseling, ministerial, and professionally related activities. Please note that a yes answer to any of the following questions will not necessarily disqualify you for the credential. If the case has been properly remedied and/or disposed of, and you are under no current ethical complaint or investigation, then the application process can proceed. Please respond to the following items by considering the appropriate box:

    1.  Have you ever been sued and/or lost (a civil malpractice action) or been criminally indicted for any actions related to your professional and/or ministerial practice?
        Yes  No
    2.  Have you ever had any professional or ministerial license revoked or suspended or had any sanctions attached to it for any actions related to your professional and/or ministerial practice? Note: in most cases, this question would apply for applicants seeking the BCPCC, BCCC, or BCPC credential.
        Yes  No  Unsure
    3.  Have you ever had your membership with any professional association suspended or sanctioned in any manner for any actions related to your professional and/or ministerial practice?
        Yes  No  Unsure
    4.  Short of formal legal-ethical action, has a client or colleague ever complained about you and/or your practice to the extent that your practice has been suspended or more closely monitored by your employing agency, practice/ministerial supervisor, regulatory/oversight board, etc.?
        Yes  No  Unsure
    5.  Has a complaint of any kind ever been lodged against you regarding your professional and/or ministerial practice, even though no formal legal, ethical, or organizational action resulted from such complaint?
        Yes  No
    6.  Have you ever been charged with or convicted of any misdemeanor or felony other than minor moving violations in a vehicle?
        Yes  No

      7. If you answered “Yes” on any items 1-6 in this section, please explain on a separate page and describe in detail the case and its disposition (no more than two pages).

    7.  I attest and affirm that I have read the 2014 AACC Christian Counseling Code of Ethics and that I will promise, to the best of my abilities, to fully adhere to and advance the tenets of this document.
        Yes  No  Unsure  (please explain)
    8.  If you are an unlicensed counselor, pastoral counselor and/or lay caregiver, have you specifically reviewed and understand the tenets of Section IV. Additional Ethical Standards for Pastoral and Lay Christian Counselors (pages 48-50)?
        Yes  No  Unsure  
    9.  I understand and consent that should I violate nationally recognized ethical standards, including the 2014 AACC Christian Counseling Code of Ethics, I may be subject to disciplinary action, up to the loss of my status as an BCPPC credential holder

        Yes  No  Unsure  

      10. If you answered “No” or “Unsure” on items 7, 8 or 9 in this section, please explain your response on a separate page and include with your application (no more than two pages).

    SECTION D: Professional/Ministerial Licensure and/or Practice Status

    Applicants must hold current, valid, and unencumbered licenses and/or certifications that are recognized by the BCPPC as meeting nationally accepted standards that demonstrate a thorough and rigorous evaluation of a person’s education, training, and qualifications. Please respond to the following items by considering the appropriate box:

    1.  Question #1 is only for licensed BCPCC applicants or BCCC applicants with a Bachelor’s degree and license – Do you hold a current, valid, and unencumbered mental health practice license by one of the 50 states, U.S. territories, or Canadian provinces?
        Yes  No  Unsure

      2. If Yes, please include copy of your license(s) and liability insurance face sheet showing coverage limits.

    2.  Do you hold a nationally recognized ordination or religious license by an appropriate endorsing entity?
        Yes  No  Unsure

      3. If Yes, please include a copy of your ordination and/or license(s).

    3. Do you hold a nationally recognized state or practice certification by a counseling, pastoral, or other ministry related endorsing entity?
        Yes  No  Unsure

      4. If Yes, please include a copy of your certification(s).