ACEC Associate Level Membership

Company

This field is for validation purposes and should be left unchanged.

This application is ONLY for those applying for membership in ACEC as an Associate Level. Please answer all questions. Completion of the application will take approximately one hour assuming you have all of the required reference material listed below.There are five levels for membership in ACEC (https://acec-association.org/membership-levels/):

Professional Membership
Master Level Membership
Thought Leader/ SME (Subject Matter Expert)
Associate Level
Corporate Level

INSTRUCTIONS: We suggest that you copy the application and fill out a draft on your computer first.

To preview the application, click here

PLEASE NOTE: Once you leave the questionnaire you will not be able to re-enter without starting over.

MATERIAL NEEDED:
Resume AND Bio
Headshot/ jpeg, png
ACEC sponsor/ contact information
List of volunteerism/pro bono/ contact information
Assessment certificates/ dates/ expiration
List of publications (i.e., books, articles, blogs, podcasts, videos)
Two referrals for membership in ACEC/ contact information

IN ADDITION:
We will furnish upon request our Code of Ethics, Anti-Discrimination Policy, Code of Conduct and Bylaws.

TECHNICAL SUPPORT:
For technical support please contact Carla Hansson at reachme@carlahansson.com

Your Personal Information

Date

Contact Information*

First Name Last Name

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone/Ext.

Cell Phone*

Email Address*

Please enter your "What's App" phone number

If you reside outside of the United States

How did you hear about ACEC?

ACEC Member

My Company

Colleague/Coworker

Email Newsletter

Facebook

Other Social Network

Blog or Article

Please enter their name so we can thank them!

Your Business Information

Upload Your Resume

Drop files here or

Accepted file types: pdf, doc, docx, pages, Max. file size: 128 MB.

Upload Your Bio*

Attach your professional bio. Accepted file extensions docx, doc

Accepted file types: doc, docx, pdf, pages, Max. file size: 128 MB.

Upload Your Photo (head shot)*

• jpeg/png
• Must use full color
• Size 200×200 Maximum

Accepted file types: jpg, png, jpeg, Max. file size: 128 MB.

Company Name*

Business Title

Business Contact Information*

First Name Last Name

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone/Ext.

Email*

Your Social Media Profile

Leave blank if you do not have one of the following.

LinkedIn URL

Facebook URL/Name

Twitter URL

YouTube Channel

Your Website and Digital Presence

Website Address

List all

Your Blog Address

List all

Guest Blogs

List all

Referrals

Below provide the name of one reference who is a member of ACEC

REFERENCE #1 Who referred you to ACEC?*

Fist Name Last

Phone*

Email*

There are two types of validation information that can be used with each application:

1. Your reference complete a form which is sent by you.
2. We may contact your reference.s

INSTRUCTIONS:

Please provide the contact information of individuals* who can verify your coaching engagements with leaders at the top tier of five organizations OR your leadership experience:

1. Information must include email and office telephone numbers.

2. References cannot be students, or relatives.

3. Approval must be included for each referral that will allow ACEC to contact them and confirm information.

* You may include the hiring contact i.e., EVP Human Resources, EVP, Talent Manager, etc., who can validate your work.

ACEC will ask the following three questions:

1. Has the leader who was coached become more effective as the result of the coaching?

2. Were the coaching goals achieved?

3. Would you hire this person to coach another leader? and why?

4. How has your leadership affected the organization?

Contact Information*

First Last

Phone*

Email*

Business Relationship*

Contact Information

First Last

Phone

Email

Business Relationship

Assessments

INSTRUCTIONS:
Identify one internationally approved and widely used assessments which you have been certified to use. Include the following:
1. The certifying body
2. Their contact information
3. The date you were certified
4. Your certification number (if used)
5. Your name at the time you were certified.
6. If your name was different at the time of certification please give both names.
7. Give your renewal date, if required.

Assessment Information #1*

(you may upload a file next)

Upload Your File

Drop files here or

Accepted file types: pdf, doc, docx, pages, Max. file size: 128 MB.

Presentations

INSTRUCTIONS:
Describe one presentation you gave to an audience larger than 50 attendees, include the following information
1. Sponsor
2. Topic
3. Evaluation
4. Goal
5. Attendee profile
6. Delivery method
7. Was this assignment: Pro Bono, Volunteer, Barter (If yes what was the exchange), Paid (If yes, what was the fee)

About Presentation:*

Your Volunteerism

INSTRUCTIONS:
Describe at least one volunteer project (may be an organization or an individual, however, family members may not be included) you are involved with. Include contact information for the headquarters/leader.
1. Describe the organizations mission.
2. What were your contributions.
3. Number of years volunteering for this organization.

Project #1:*

Contact Information*

First Name Last Name

Phone*

Email*

Project #2:

Contact Information

First Last

Phone

Email

Your Education/ Schools

INSTRUCTIONS:
For each institution include the following:
1. School name and location
2. Major
3. Minor
4. For post graduate school include your dissertation topic

Undergraduate (Baccalaureate)*

Click on ⊕ to add another row

School

Location

Click on ⊕ to add another row

Major

Minor

Graduate School ( i.e.) Masters, A.M. or S.M.

Click on ⊕ to add another row

School

Location

Click on ⊕ to add another row

Major

Minor

Post Graduate

(Ph.D) (INCLUDE YOUR DISSERTATION TOPIC)
Click on ⊕ to add another row

School

Location

Dissertation

Who would you recommend for membership that we can contact?

(Please list two)

Name*

First Last

Phone

Email*

Have vou discussed ACEC with them?

What is their Linkedln profile URL?

Name

First Last

Phone

Email

What is their Linkedln profile URL?

Have vou discussed ACEC with them?

Are you a member or where you referred by a member of the "Coaching Network?"*

Please enter yes or no, or referral name

Code:

Please enter a discount code if you have one

Please sign here*

Your Signature represents the following:
1. I agree that the information submitted with this application is provided freely and carries no obligation.
2. You guarantee that the information submitted is true.
3. You agree to the rules and regulations for the use of your certification as detailed in MEECO Institute’s Code of Conduct; ethics and bylaws, disclaimer and its code of ethics listed on the ACEC (https://www.acec-association.org) and the MEECO Institute website (https://www.meeco-institute.org).
4. We may validate the information you have submitted.

By clicking submit, I agree to the processing of personal data and with the privacy policy and terms and conditions.

ACEC ACEC Associate Level Membership

PROFILE FOR: ACEC Associate Level Membership

Your Personal Information

Your Business Information

General Information

Your Social Media Profile

Your Website and Digital Presence

More About You

Professional Organizations

Referrals

Assessments

Presentations

Your Volunteerism

Your Education/ Schools

Who would you recommend for membership that we can contact?

Contact