ACPE Service Awards Nomination Form

ACPE Service Awards Nomination Form
Please note: There is no option to save your submission. Please complete all fields before submitting your application.
Nominator’s Information
Date

MonthDayYear
Date
Name of Person Submitting Nomination

First NameLast Name
Relationship to the Award Nominee
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Are you a member of ACPE?

YesNo
If yes, what is your membership category?

Nominee’s Information
Name of Person Nominated for an ACPE Award

First NameLast Name
Is this person a member of ACPE?

YesNo
If yes, what is their membership category?
If no, how are they affiliated with ACPE?
Please indicate the ACPE Service Award of which you are nominating this person. You can only select one award. Please review the criteria for each award before making your selection.
Award Criteria
Distinguished Service AwardHelen Flanders Dunbar AwardEmeritus ACPE Certified Educator/PsychotherapistInspiration AwardEmerging Leader Award

Essay Questions for the Distinguished Service Award Nominee
Please explain why the Nominee should be recognized among their colleagues as a recipient of ACPE’s most prestigious honor, the Distinguished Service Award. Include any significant contributions or accomplishments this person has made to ACPE and/or the spiritual care & education field.
500 words or less
Nomination Attachments:

Please upload the following documents with your Distinguished Service Award nomination form:

1. A one-page biographical statement about the Nominee

2. Three letters of Support

a. One from an ACPE colleague other than the Nominator
b. One from a student of the Nominee
c. One from another person of the Nominee’s Choice
One-page biographical statement about the nominee

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Please attach three letters of support:
One statement from an ACPE colleague other than the Nominator

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One statement from a student of the Nominee

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One statement from another person of the Nominee’s Choice

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Essay Questions for the Helen Flanders Dunbar Award Nominee
Please explain how the Nominee has demonstrated one or more of the following: innovative spiritual care practice; contributed to research and academic vitality in the field of spiritual care & education; leadership at a critical juncture in ACPE’s history; contributed to a new expression or direction of ACPE.
500 words or less
Nomination Attachments:

Please upload the following documents with your Helen Flanders Dunbar Award nomination form:

1. A one-page biographical statement about the Nominee

2. Two letters of Support

a. One from an ACPE colleague other than the Nominator
b. One from another person of the Nominee’s Choice
One-page biographical statement about the nominee

Browse Files

Cancelof
Please attach two letters of support:
One statement from an ACPE colleague other than the Nominator

Browse Files

Cancelof
One statement from another person of the Nominee’s Choice

Browse Files

Cancelof

Essay Questions for the Emeritus ACPE Certified Educator/Psychotherapist
Please explain how the Nominee has made significant contributions to students, clinical pastoral education and spiritually integrated psychotherapy through teaching and/or scholarship in the spiritual care & education field.
500 words or less
Nomination Attachments:

Please upload the following documents with your Emeritus ACPE Certified Educator/Psychotherapist nomination form:

1. A one-page biographical statement about the Nominee

2. Three letters of Support

a. One from an ACPE colleague other than the Nominator
b. One from a student or mentee of the Nominee
c. One from another person of the Nominee’s Choice
One-page biographical statement about the nominee

Browse Files

Cancelof
Please attach three letters of support:
One statement from an ACPE colleague other than the Nominator

Browse Files

Cancelof
One statement from a student of the Nominee

Browse Files

Cancelof
One statement from another person of the Nominee’s Choice

Browse Files

Cancelof

Essay Questions for the Inspiration Award
Please describe the mid-career milestone or accomplishment that explains why the Nominee should be a recipient of the ACPE Inspiration Award. We invite you to also share an example of how the Nominee has demonstrated creative leadership and service to ACPE through their initiative, innovation and/or scholarship at their local center, through their Community of Practice and/or at the ACPE national level
500 words or less
Nomination Attachments:

Please upload the following documents with your Inspiration Award nomination form:

1. A one-page biographical statement about the Nominee

2. Two letters of Support

a. One from an ACPE colleague other than the Nominator
b. One from another person of the Nominee’s Choice
One-page biographical statement about the nominee

Browse Files

Cancelof
Please attach two letters of support:
One statement from an ACPE colleague other than the Nominator

Browse Files

Cancelof
One statement from another person of the Nominee’s Choice

Browse Files

Cancelof

Essay Questions for the Emerging Leader Award
Please describe how the Nominee exemplifies a new generation of creative leadership and service to ACPE through their initiative, innovation and/or scholarship at their local center, through their Community of Practice and/or at the ACPE national level.
500 words or less
Please explain how this award might further equip the Nominee for greater leadership opportunities in ACPE and the wider spiritual care & education field.
500 words or less
Nomination Attachments:

Please upload the following documents with your Emerging Leader Award nomination form:

1. A one-page biographical statement about the Nominee

2. Two letters of Support

a. One from an ACPE colleague other than the Nominator
b. One from another person of the Nominee’s Choice
One-page biographical statement about the nominee

Browse Files

Cancelof
Please attach two letters of support:
One statement from an ACPE colleague other than the Nominator

Browse Files

Cancelof
One statement from another person of the Nominee’s Choice

Browse Files

Cancelof