NIBIC Membership Application
Download Application Below
NIBIC Membership Levels: Clinical Member; Professional; Associate; Student
(See next section for a description of the levels)
Name: ______________________________________________________________________________________
Date of Birth: _____________________________
Address: ____________________________________________________________________________________
SSN: ______________________________________
Phone (work): _____________________________
Phone (cell): _______________________________
E-mail: ____________________________________
Fax: _______________________________________
Faith Group / Endorser: _____________________________________________________________________
Date of Ordination/Commissioning: ________
Endorsing Agent: ____________________________________________________________________________
Phone:__________________________
Address:__________________________________________________________________________
Your Employer: ______________________________________________________________________________ Your Title: _________________________________
Supervisor: __________________________________________________________________________________
Title: ______________________________________
Number of people for whom you provide services in the workplace: ___________________________
Education: List all colleges, universities and seminaries attended.
INSTITUTION; LOCATION; DATES ATTENDED; DEGREE
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Clinical Pastoral Education, other Specialized Clinical Training, Licenses and Certifications _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Professional organizations of which you are a member and at what level
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Provide the following with this application form: (See the accompanying standards for further explanation.)
* NIBIC Code of Ethics Statement, signed
* Documentation of theological and clinical training
* Short Autobiographical Essay
* Endorsement and Ordination/Commissioning Certificate
Circle membership category for which you are applying:
Clinical Member; Professional Member; Associate Member; Student Member
I attest that all information I have provided regarding the membership process is true. I also understand that membership does not imply in any way that NIBIC is legally liable for the individual actions of its members. Membership affirms that the member has met the standards of professional preparation for that level of membership.
Signature: _____________________________________________________
Date Signed:_______________________
NATIONAL INSTITUTE OF BUSINESS AND INDUSTRIAL CHAPLAINS
BRIEF DESCRIPTION OF MEMBERSHIP LEVELS
Download Below
NIBIC Board Certified Chaplain (NBCC)
A Board Certified Chaplain in NIBIC meets all the requirements of a Clinical Member plus: has one full year of professional experience as a NIBIC Clinical Member; shows advanced competence in a specialized area of business or industrial chaplaincy; completes professional continuing education annually, demonstrates professional leadership and spiritual care-giving identity; and demonstrates an understanding of and commitment to NIBIC’s Code of Ethics.
Reciprocal NIBIC Board Certification may also be granted to new NIBIC members with current Board Certification granted from another professional organization that has standards similar to NIBIC’s and who is employed in corporate chaplaincy.
Clinical Member
A Clinical Member is an ordained or commissioned minister with an undergraduate degree and Master of Divinity degree or equivalent from DOE regional or ATS accreditation, who has been approved or endorsed as a chaplain by his or her faith group, has four units of Clinical Pastoral Education (CPE) or equivalent, and (1) is employed as a workplace chaplain, or (2) whose job relates to spiritual care in workplace settings. A clinical member also demonstrates an understanding of and a commitment to NIBIC’s Code of Ethics.
Professional Member
A Professional Member is an ordained or commissioned minister endorsed by his or her faith group and (1) is employed as a chaplain in business or industry, or (2) whose job relates to workplace chaplaincy. A professional member also demonstrates an understanding of and a commitment to NIBIC’s Code of Ethics.
Associate Member
An Associate Member (1) is not employed in workplace chaplaincy, but who is actively exploring such a ministry, (2) or a person who activity supports spiritual care in the workplace.
Student Member
A Student Affiliate is a student at any level of education who is interested in workplace ministry as a vocation.
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