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. The checkboxes are simply there to assist you in going through the questions/items.

SECTION A: Christian Personal Testimony

The foundation to all work and identity as a Christian crisis responder 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 Crisis Response Testimony

The practice of Christian crisis response genuinely incorporates scriptural truths, biblical principles and guidance, and a Christian value system into one’s caregiving/ministerial practice, theoretical orientation, and professional life. The BCCTR is dedicated to credentialing Christian crisis responders, not simply people 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 caregiving/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 BCCTR) the required number of contact hours that incorporates biblical principles and crisis response skills with theory, knowledge, and practice for the credential I am seeking.
      Yes  No  Unsure
    • 24 contact hours to achieve the Board Certified First Responder credential
    • 60 contact hours to achieve the Board Certified Crisis Response Specialist credential
    • 60 contact hours to achieve the Board Certified Crisis Response Chaplain credential
    • 60 contact hours to achieve the Board Certified Crisis Response Therapist credential

  3.  If you have not completed your contact hours through approved activities or programs, do you have a record of other training (e.g., Basic CISM training through ICISF, etc.) you have received or evidence showing publications, programs and/or presentations you have done that you would like the BCCTR Credentials Committee to evaluate as a substitution for this requirement?
      Yes  No  N/A (if “Yes,” please inlcude the appropriate documentation.)

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 crisis response work, 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?
      Yes  No  N/A
  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  N/A
  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
  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).

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