Certified Member Complaint Form - Association of Certified Biblical Counselors

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I have read and have agreed with the Member Complaint Case Policy and affirm that the answers to the questions in this form submission are truthful and are according to the requirements expressed in ACBC policy.

Yes

If this is a problem in regards to someone else, I have spoken privately with them about the matter according to the principles found in Matt. 18:15.*

Yes

No

N/A

Please provide a brief explanation as to why you did not speak privately with the individual in question.

Please note that ACBC Member Care is not able to process nor investigate your complaint if you have not followed the guidelines of Matthew 18 before registering a formal complaint.

Please provide a brief explanation as to why you selected this option.

Please note that ACBC Member Care is not able to process nor investigate your complaint if you have not followed the guidelines of Matthew 18 before registering a formal complaint.

I agree that ACBC may share my statements with those involved according to Prov. 18:13 and Prov. 18:17*

Yes

No

N/A

Please provide a brief explanation as to why you selected this option.

Please note that Member Care is not able to process nor investigate your complaint if our office does not have permission to communicate in accordance with the passage above.*

I understand

1. Your Information:

Name*

First Last

Email*

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date you were ACBC Certified

This could also include the phase of the process you are currently in (if applicable).

Place of Training (if applicable)

2. Member or Party About Whom Complaint or Request is Made:

Name*

First Last

Present Ministry Title(s) (if applicable)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Relation to You*

3. Additional Parties Involved? (If so, fill out the following):

Name of Additional Party Involved (if applicable)

First Last

Present Ministry Title(s) (if applicable)

Phone

Email

Relation to Member or Party About Whom Complaint or Request is Made:

Name of Additional Party Involved (if applicable)

First Last

Present Ministry Title(s) (if applicable)

Phone

Email

Relation to Member or Party About Whom Complaint or Request is Made:

4. Problem/Complaint:

Please briefly summarize the problem or complaint in one or two sentences.*

5. The Details:

We ask that you answer each question as requested. Please keep answers concise, relevant to the question at hand, and to the point.

A. Provide brief and relevant details relating to the stated problem or complaint.*

B. What were your initial responses (please include attitude, words, and actions)*

C. What specifically have you done in speaking clearly about the problem or complaint with the other person?*

D. What other steps have you taken to resolve the situation?*

E. Do you have any evidence or witnesses to support your claim(s)? You can provide in the space below an outline of support along with the contact information for those who may be able to corroborate your claim(s)?*

Please note that ACBC Member Care must rely on an evidentiary process in response to complaints

F. Supplemental Evidentiary Documents

Drop files here or

Accepted file types: docx, jpg, pdf, Max. file size: 80 MB.

If you happen to have any evidence that you would like to submit for us to review, you may submit those documents here.

6. Expectations

A. What are your desires/expectations in bringing this to ACBC Member Care?*

B. Is this an urgent/time sensitive matter? (If yes, explain)

Electronic Signature*

By entering your first and last name and date in the spaces below, you are signing to your name in agreement with the above statement:

First Last

ACBC Role and Commitment

Please read the below and initial.

The role and promise of Member Care is to support and assist our counselors, to receive complaints, and to ensure our counselors are upholding ACBC and biblical standards for quality biblical care. Our commitment to every complainant is to take their matter seriously, to fully process their complaint (if the grievance has already been discussed with the offending party), and to respond appropriately: (1) to ensure the upholding ACBC Standards (2) to provide our counselor with any needed guidance or instruction, (3) to initiate any needed remedial measures, and/or (4) to modify the certification status when warranted. Member Care must keep confidential any details of an investigation and its response to findings, but can provide the complainant with another avenue of care when warranted and can disclose the certification status of an ACBC member. While the Member Care office does not engage in actual mediation between parties, when applicable, it will offer guidance to both complainant and counselee on how to best pursue reconciliation or resolution that utilizes God-prescribed methods in tandem with the biblically ordained authorities of church, home and State.*

Please initial above.

Date*

Please date above.