APPLICATION FOR APPOINTMENT
NACC ETHICSAPPEALS PANEL

Please email your application to Ramune Franitza at

Date of Application:______Email: ______

Name: ______

Highest Degree or Credentials: ______

Position: ______

Place of Ministry: ______

Mailing Address:______

Telephone:  Cell: ______ Home: ______ Work: ______

Membership #:______Membership Category: ______

 Certified  Not Certified Certification year: ______

List your places of Ministry in the past ten years with dates. Please include your current Ministry:

Place of Ministry / Location / Dates

Ethics Appeals Panel Purpose

To review appeals of the Ethics Commission decisions in accordance with NACC Standards and Procedures

Major Responsibilities

  • Reviews the decision for any procedural error.
  • Prepares a written summary of the findings for the Board of Directors.
  • Recommends a resolution of the appeals to the Board of Directors.

State your reason for seeking this position:

Membership Criteria for Ethics Appeals Panel

  • NACC membership
  • Active as a Board Certified Chaplain or CPE Supervisor
  • Or Retired-Certified with continuation of certification renewal process
  • Demonstrated knowledge and understanding of the NACC Code of Ethics and Procedures for processing ethical complaints.
  • Understands and articulates the distinction in the roles of the Ethics Commission and the Ethics Appeals Panel.
  • Experience in processing complaints of an ethical nature preferred.
  • Three to five years’ experience with ethics committees within places of employment or elsewhere.
  • Preferably, although not an absolute requirement, has been a prior member on NACC Ethics Commission and is aware of ongoing ethical issues.

Time Commitment

  • This commission meets on an ad hoc basis to address ethics complaints as they arise. It usually convenes by conference call at least twice a year to review its responsibilities and determine how best to keep educated on the NACC Ethics Standards and any other ethics learning.

List specific professional and experiential examples to support your qualifications for this position:

List previous offices, positions held and involvement in the NACC and any pastoral care, counseling or educational organization (local, state/regional, and/or national) with names and date of service:

Office/Position / Location / Dates

Identify courses, seminars, and symposia you have (A) Attended or (P) Presented that support your qualifications:

A=Attended / P=Presented / Course name / Dates

Identify two individuals (one who is not affiliated with NACC) who could attest to your interest, qualification and abilities, including contact information:

Reference #1
Name:
Position:
Place of Work:
Phone:
Email:
Reference #2
Name:
Position:
Place of Work:
Phone:
Email:

In order to be considered for appointment each statement must be initialed:

______My membership in NACC is active.

______I understand that filing this application does not automatically ensure appointment.

______I have read the Roles, Responsibilities and Criteria for the NACC EthicsAppeals Panel

______I have reviewed my time commitments and am able to balance my work commitments accordingly.

______

Applicant Signature Date

Rev. 6/20171