Concern or Complaint Form - Association of Certified Biblical Counselors

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

Yes

No

N/A

Please note that our Member Care Department is not able to engage your complaint if you have not followed the guidelines of Matthew 18 before registering a formal complaint.

I understand

I agree that you may share my statements with those involved (Proverbs 18:13 & Proverbs 18:17)?*

Yes

No

N/A

Please note that our Member Care Department is not able to engage your complaint if they do not have permission to communicate in accordance with the passages 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, or current stage of the process you are 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:

Problem/Complaint in One or Two Sentences:*

5. The Details:

A. Briefly explain the situation/problem:*

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

C. What specifically have you done in speaking clearly about the issue (concern) with the other person?*

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

6. Expectations

Your Desires/Expectations in Bringing this to Member Care:*

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

Consent*

I commit that the above information is accurate and truthful to my knowledge.

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

Date*

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.