ACEC Master Level Membership

This application is ONLY for those applying for membership in ACEC as a Master Level. Please answer all questions. Completion of the application will take approximately two to three 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: Due to the steep requirements to become certified as Master Corporate Executive Coach (MCEC) this application is very comprehensive and contains 72 questions that address requisite areas of experience and expertise. We suggest that you copy the application and fill out a draft on your computer first.

WE STRONGLY RECOMMEND THAT YOU DOWNLOAD AND COMPLETE A WORKING COPY OF THE APPLICATION BEFORE FILING ONLINE,
DOWNLOAD YOUR WORKING COPY OF THE APPLICATION HERE

PLEASE NOTE: Once you leave the questionnaire you will not be able to re-enter without starting over. You must SAVE your application BEFORE EXITING.

When clicking on “To Save and Log Out…” link at the bottom of the page, you will be prompted to enter your email address into a window. Please double check your email is entered correctly. Once submitted, you will receive an email with your individual save link. This link is valid for 90 days. IF YOU DO NOT SAVE YOUR APPLICATION BEFORE EXITING, YOUR INFORMATION WILL BE LOST.

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
Case Study

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 of Application

Contact Information*

First Last

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

Telephone/Ext.

Cell Phone*

Please enter your "What's App" phone number

If you reside outside of the United States

Email*

Your Business Information

Upload Your Resume*

Drop files here or

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

Upload Your Bio*

Drop files here or

Accepted file types: pdf, pages, doc, docx, 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*

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!

If you have an ACEC Membership, when did you become a member?

Please confirm that you have professional liability insurance*

Yes

No

General Information

COACHING:*

Preferred coaching methodology(ies).

MARKETING:*

What sales/marketing do you actively participate in to promote your business? Identify three types currently being used.

PASSIVE INCOME:*

Identify two areas of professional passive Income i.e. speaking engagements, affiliate marketing, publication etc.

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 Blog

List all

Referrals

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 references

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?

REFERENCE #1 Contact Information*

First Name Last Name

Phone*

Email*

Business Relationship*

REFERENCE #2 Contact Information*

First Name Last Name

Phone*

Email*

Business Relationship*

REFERENCE #3 Contact Information

First Name Last Name

Phone

Email

Business Relationship

REFERENCE #4 Contact Information

First Name Last Name

Phone

Email

Business Relationship

REFERENCE #5 Contact Information

First Name Last Name

Phone

Email

Business Relationship

Assessments

INSTRUCTIONS: Identify two 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 Below

Drop files here or

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

Assessment information #2*

(you may upload a file next):

Upload Your File Below

Drop files here or

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

Presentations

Describe two presentations you gave to audiences larger than 100 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?) or paid? (If yes what was the fee)

About Presentation #1:*

About presentation #2:*

Your Volunteerism

INSTRUCTIONS:
Describe at least two volunteer projects (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

Email*

Phone*

Project #2:

Contact Information

First Name Last Name

Email

Phone

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 School (Baccalaureate)*

Click on ⊕ to add another row

School

Location

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 School (Ph.D)

(INCLUDE YOUR DISSERTATION TOPIC)

School

Dissertation

Case Study

INSTRUCTIONS:
1. Upload a case study which demonstrated your master level executive coaching strengths and your problem solving abilities. We reserve the right to validate this information.
2. You may upload a file on the next page.

Upload Your File Below*

Drop files here or

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

Client Contact Information*

First Name Last Name

Phone*

Email*

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

Have vou discussed ACEC with them?

What is their Linkedln profile URL?

Are you a member or where you refefered 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 guarantees 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.