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Pastoral Care Specialist

 

 
APPLICATION INSTRUCTIONS
 
PASTORAL CARE SPECIALIST
                                                                             
 
APPLICATION MATERIALS AND PROCESS:
·        Enclosed are materials for making application for new individual membership or change of category. These include the following: 
 
o Application Form
o AAPC Code of Ethics
o List of Processing Fees
 
·        It is important that you read the entire application and accompanying materials before beginning completion of the application form. Carefully follow the instructions contained in the application form. If you have questions, concerning the completion of the application and/or required documentation, contact the Association Office.
 
·        Mail ONE collated, unstapled copy of the completed application, INCLUDING ALL SUPPORTING DOCUMENTATION, along with the appropriate Processing Fee, to the Association Office at the address on this letterhead. Make an additional copy of the application for your records. Faxed applications will not be accepted. NOTE: The Association Office assumes no responsibility for collecting or copying application materials.
 
·        Membership applications will be reviewed upon receipt in the Association Office provided they are complete, including all supporting documentation. Applicants will be notified if documentation is missing. Applications incomplete after six months will be closed.
 
·        Applicants will be notified as soon as a decision has been reached on the application.
 
PROCESSING FEES:
·        Processing fees are listed on an enclosure to this packet and must accompany the application.   NOTE: Processing fees are not refundable. Include only the processing fee with your application.



AMERICAN ASSOCIATION OF PASTORAL COUNSELORS
 
PASTORAL CARE SPECIALIST APPLICATION
 (Please PRINT/TYPE all information clearly)
 
Date                                                    AAPC Member No.                                        .
                                                                                                                                (if applicable)
I.       PERSONAL
 
Name                                                                                                                                 
                (Last)                                   (First)                                (Middle)
 
Official Mailing Address:                                                                                          
 
                                                                                                 
 
                                                                                                 
    (City)                              (State)          (Zip - 9 digits)
 
Phone Numbers: indicate whether office (o) or home (h):
 
          Primary                                             Secondary                                          
 
Fax No:                                               E-mail Address:                               
 
Date of Birth                           Gender          Religious Endorsing Body                    

          Race: (For Demographics)  
Caucasian _____ African American______ Asian_______ Hispanic_______ Other_______                              _     
 
Highest degree achieved                          Licenses held                                          
 
Have you ever been under disciplinary action by any professional organization or licensing board, or have you ever had a felony conviction?   YES         NO         If yes, please attach a brief description of the issue and the action taken.
 
II.      CURRENT PROFESSIONAL POSITION AND RESPONSIBILITIES
 
A.      Employer:                                                                                                                   
Address:                                                                                                                     
__________________________________________________________________________________
Position/Title:                                                              How long?                    To whom are you responsible?                                                                                     Description of your work:                                                                                          
                                                                                                                                 
 
 
B.      Letter of Recommendation.
 
Submit a letter of recommendation from an official of your local faith group.
 

 III.   SMALL GROUP AND INDIVIDUAL COUNSULTATION EXPERIENCE
 
A.     Submit a letter or diploma from an AAPC Fellow, Diplomate or AAPC approved training program indicating that you have completed fifty (50) hours of small group consultation dealing with such topics as brief term, supportive counseling methods, crisis intervention, grief and loss, divorce recovery, pastoral diagnosis, referral, and the application of pastoral care principles in the broader functions of ministry. Topics focus upon the theoretical foundations and practical aspects of pastoral care and supportive counseling. Special attention will be given to supportive techniques for use in short-term, grief, marital, divorce and crisis intervention counseling and to issues and problem areas cited by the participants. Clinical consultation will be conducted within a group atmosphere of acceptance and support where participants will share verbatims of brief pastoral care and counseling experiences in order to foster personal and professional integration and skill development as a pastoral care specialist. Peer support group meetings provide a confidential setting in which personal growth is encouraged through:
a.      Processing of feelings and reactions
b.      Exploration of personal and professional issues
c.      Feedback from peers
d.      Prayer and sharing of one’s faith journey.
 
B.     Individual consultation of up to twenty (20) hours may be substituted for twenty (20) hours of group supervision.
 
Name ofConsultant:                                                                                
 
AAPC Certification during consultation:          Diplomate             Fellow
 
IV.     CURRENT ON‑GOING CONSULTATION:
 
On-going consultation is recommended, at least quarterly.
 
Name of Consultant:                                                                               
  
                AAPC Certification:             Diplomate          Fellow
 
If non-AAPC, Profession:                                                   
(Other professionals may provide consultation if affiliated with a pastoral counseling center.)
 
Frequency of Consultations (at least quarterly):                                           
 
 
 V.     AAPC LEADERSHIP
Considering the mission of AAPC and the reality that ours is a volunteer community,
o       How are you hoping the organization will help facilitate your growth?
o       How would you like to see yourself involved?
o       What do you feel you would like to bring to the community?
 
                                                                                                                                           
                                                                                                                                           
                                                                                                                                           
                                                                                                                                           
                                                                                                                                           
                                                                                                                                           
 
VI.     STATEMENT OF COMPLIANCE
 
I understand the responsibilities and obligations of membership in the American Association of Pastoral Counselors and agree to abide by its Code of Ethics, and to pay dues and submit reports as required to remain in good standing.
 
I also understand that personnel of the Association will review and act upon this application, and I agree to hold such personnel, the Association, and its officers and agents harmless with respect to action they may take in connection with such review.
 
I also understand that the processing fee is non‑refundable.
 
 
                                                                                                               
                        Date                                                    Signature
 
ATTENTION:    HAVE YOU . . . .
 
 1.     CHECKED THIS APPLICATION TO INSURE ALL REQUIRED DOCUMENTATION HAS BEEN INCLUDED?
 
2.       PREPARED ONE SET (collated, no staples) OF THE APPLICATION AND ALL   DOCUMENTATION? (Made a second copy to keep for your records.)
 
Update: 11/15/11