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CPE with ClinicalChaplaincy
Application for Clinical Pastoral Education/Training
Name
*
First Name
Last Name
Your contact info
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
About your education/training/background/experience
Denomination/Faith Group
*
Jurisdiction/District/Diocese/Conference/Assoc:
Ordained/Licensed/Appointed:
College: Degree/Date:
Seminary: Degree/Date:
Grad Schl: Degree/Date:
List your prior CPE dates, with the center's name and address, and the training supervisor's name
Respond to the following questions
1) Autobiographical Reflection: Provide a reflective autobiographical account of your life giving attention to pivotal life events and relationships that have shaped who you are as person. Please be specific and personal.
2) Helping Incident: Describe a situation where you provided help to someone(s) facing a difficult life situation. Please supply a reflective critique of your intervention. Applicants who have been in CPE training will address this question by providing a Clinical Case.
3) CPE/CPT Training: What’s your understanding of Clinical Pastoral Education/Training and what do you hope to gain for your personal/professional development?
4) Curriculum Vitae: Please provide a brief Curriculum Vitae that documents your education, training and work experiences.
When you click the "submit" button, your responses will be automatically emailed to the UVH CPE Supervisor, David Roth
Thank you!
