Appendix 1: Accountability for Ethical Conduct Policy Report Form

For the purposes of this Policy, "member" refers to: ACPE Certified Educators, ACPE Associate Certified Educators, Active Retired Supervisors, Certified Educator Candidates, and Spiritual Care Professionals.

I certify that (a) no discipline or corrective action arising from a complaint of unethical or felonious conduct has been imposed on me, and no complaint against me for unethical or felonious conduct is pending in a civil, criminal, ecclesiastical, employment, or another professional organization's forum; and, (b) I have never resigned, been transferred or terminated, nor negotiated a settlement from a position for reasons related to unethical or felonious conduct. 

If the above cannot be certified, please provide an account of the complaint including the forum, the charges, and the final outcome. Provide the names of people involved in the process whom you authorize to provide full information to ACPE representatives. Prior actions are not an automatic bar to ACPE membership. Each situation will be evaluated on its own mertis by an Accountability Review Committee composed of the Executive Director, the Chair of the Professional Ethics Commission (PEC), the Chair of the Certification Commission, the PEC legal consultant, and a designated Board Member. ACPE has the right to extend or deny candidacy status or membership regardless of previous complaints, other forum's findings or subsequent remedial actions according to the judgement of the named representatives to the Accountability Review Committee on behalf of the Association. If denied, the applicant may resubmit an application at a later time. Decisions are final and binding on ACPE. (Attach pages if necessary.)

I understand that as a condition of membership in ACPE, I will provide to the Association timely notice of any complaint of unethical or felonious conduct filed against me. I agree to provide to the ACPE Professional Ethics Commission in a timely fashion the information it requests regarding the invesigation, 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 ACPE.