Clinical Pastoral Application

Are you ready to take the next step in your journey? We welcome you to complete an application for our Clinical Pastoral Education (CPE) programs.

This application should be submitted for all CPE programs, including residency, summer internship, extended internship and certified educator education.

Questions with an (*) require information to be entered in order to submit your application.

Read instructions and review this online form carefully before completion. Several responses include the attachment of electronic documents, such as resumes. Please prepare or accumulate these documents prior to beginning the completion of this form.

All questions must be completed. International applicants have additional requirements and deadlines.

Fields marked with * are mandatory. Please enter N/A if appropriate.

Which program is this application for? *

Summer

Extended

Residency (only at York)

Certified Educator CPE

Your Name *

Mailing Address *

City *

State *

Zip Code *

Country *

Telephone *

Email *

If different from above, add your permanent address, city, state, zip code, country, and telephone.

Permanent Address

City

State

Zip Code

Country

Telephone

Denomination/Faith Group Affiliation *

Jurisdiction/District/ Diocese/Conference/Association *

Ordained/Licensed/Appointed *

Present Position *

High School: Degree/Date *

College: Degree/Date *

Seminary: Degree/Date *

Grad School/Other: Degree/Date *

Previous Clinical Pastoral Education

Date

Center

Certified Educator

Date

Center

Certified Educator

Date

Center

Certified Educator

Attachments

Accepted file types: .pdf, .jpg, .png

20MB total file size limit

An account of your life *
Include significant persons and events (e.g. marriages, divorces, children, deaths, etc.) as they have impacted your growth and development. Describe your family of origin, current family relationships, and significant social relationships and their impact on your ministry. Two pages

A description of your spiritual growth and development *
Describe your faith development/history and include personal conversions, call to ministry, and significant persons and events that have impacted your spiritual growth and development. Indicate your current relationship with faith group-faith group authority person and present standing with your faith group. Two pages

A description of your work (vocational) history *
Include a chronological list of jobs/positions dates of employment and a brief statement of your current employment and work relationships. A resume is sufficient. Two pages

Applicants with previous CPE should attach copies of all previous self and supervisor evaluations. *

A recent account of a 'helping incident' in which you were in a pastoral/spiritual role with the person/family that you were providing “help”/ministry. *
Four pages a. Include the nature of the request, your assessment of the issue and a brief evaluative summary of what you did and how you helped. b. If you had prior CPE, please use verbatim format and indicate the most significant learning in your previous training.

Your impressions of Clinical Pastoral Education *
One page a. Indicate what you believe CPE to be. b. Indicate if CPE is being required of you. c. List personal/professional strengths/weaknesses. List two learning goals for this program and how CPE training will help you address them. One page a. Please list personal/professional strengths/weaknesses. b. Indicate any personal/professional learning goals and how this training will address your learning and/or vocational goals.

For international students, WellSpan’s requirement is a submitted application by September 1 of the year prior to entry. You will have to obtain appropriate documentation from U.S. Immigration, which requires a visa and a US Social Security number. This documentation should be approved at least 6 (six) months prior to the program. See http://www.acpe.edu/StudentsIntlStudents.html (ACPE website)

If offered employment, can you submit verification of your legal right to work in the U.S.?

Yes

I hereby give my consent to the ACPE center to which I am applying to access my CPE evaluations and supervisory personnel about matters pertaining to this application.

Captcha *