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Clinical Pastoral Education Application

Online Application

Applying For
Select Program:*
- Fall
- Spring
- Summer
- Extended Unit
- 12-Month Residency
Anticipated Start Date:*
Date Format: MM slash DD slash YYYY
Applicant Info
Name:*
First Last
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Cell Phone #:*
Alternate Phone #:*
Email:*
Enter Email Confirm Email
Denomination/Faith Group Affiliation:*
Jurisdiction/District/Diocese/Conference/Association:*
Jurisdictional Authority (name/title):*
Local Church & Ministry Position (if applicable):
Position Type:
Date:
Highest Level of Education:*
Last Attended Date:*
Date Format: MM slash DD slash YYYY
Prior CPE
You will need to submit copies of ALL previous self-final evaluations and ALL previous supervisory final evaluations for programs listed below:
CPE #1
Date
Date Format: MM slash DD slash YYYY
Center Name
Supervisor Name
CPE #2
Date
Date Format: MM slash DD slash YYYY
Center Name
Supervisor Name
CPE #3
Date
Date Format: MM slash DD slash YYYY
Center Name
Supervisor Name
Academic Reference
Name*
First Last
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Denominational Reference
Name*
First Last
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Professional Reference
A person who can speak to your readiness to take CPE.
Name*
First Last
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Long-Form Questions
1. Provide an account of your life*
Include, for example, significant and important persons and events, especially as they have impacted, or continue to impact, your personal growth and development. Describe your family of origin, current family relationships, and important and supportive social relationships.
2. Describe Your Spiritual Growth and Development*
Include, for example, the faith heritage into which you were born and describe and explain any subsequent, personal conversions, your religious vocational call, religious experiences, and significant persons and events that have impacted, or continue to impact, your spiritual growth and development.
3. Describe Your Work History*
Include a chronological list of jobs/positions/dates of employment and a brief statement about your current employment and work relationships.
4. Describe a “helping incident” in which you were the person who provided the help*
Include the nature and extent of the request, your assessment of the issue(s), problem(s), situation(s). Describe how you came to be involved and what you did. Give a brief, evaluative commentary on what you did and how you believe you were able to help. If you have had prior and recent CPE, please attach a copy of a recent verbatim as your 'helping incident' and add to the verbatim your own notes on how and what you learned from sharing this verbatim with your supervisor and/or peers. If you have had CPE, but it was more than two years ago, include a recent account of a helping incident, written up in a verbatim format. If possible, include feedback from religious/spiritual colleagues and/or administrative supervisor.
5. Describe Your Impressions of Clinical Pastoral Education*
Indicate, for example, what you believe or imagine CPE to be. Indicate if CPE is being required of you. Indicate any learning goals or issues of which you are aware and would like to address in CPE. Finally, indicate how CPE may be able to help you meet needs generated by your ministry or call to ministry. If you have had prior CPE, please indicate the most significant learning experience you had during CPE. State how you have continued to use the clinical method since your previous experience. Indicate strengths and weaknesses that you have as they relate to your ministry and your identity as a professional person. Indicate any personal and/or professional learning goals and issues that you have at this time and how you believe that CPE will help you to attain or address these learning goals and issues.
6. Describe Your Site Placement Preference*
If you indicated a site placement preference, please write about this preference. If you have a preference in placement sites, please elaborate on the factors important in how you came to that preference. (this answer may be used in determining your interviewing process and team of interviewers, so please include all factors important in your decision preference).
Acknowledgements
Have you ever been convicted or pled nolo to a misdemeanor, a felony, or other crime?*
- Yes
- No
Consent*
I agree to the application policy.
I understand that neither my submission of this application, nor any subsequent invitation for an interview by a representative of Center for Spiritual Care and Education, constitutes an offer of enrollment in any of the Center for Spiritual Care and Education Clinical Pastoral Education Programs.

In the event that my application to a Clinical Pastoral Education program is denied, I understand that the Center for Spiritual Care and Education is not obligated to provide me with a reason for its denial.

I hereby give my consent to Grady Center for Spiritual Care and Education to access my CPE evaluations, supervisory personnel, and references about matters pertaining to this current application.
Application Fee
Application Fee*
Price: $50.00
Credit Card

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Card Number Expiration Date Security Code Cardholder Name

The application fee is non-refundable.

All completed applications will be reviewed by Grady Center for Spiritual Care and Education to conduct an evaluation of the applicant’s qualifications. Only qualified applicants will be invited to complete an admissions interview as part of the application process.

Clinical Pastoral Education Application

Online Application

Applying For

Applicant Info

Prior CPE

Academic Reference

Denominational Reference

Professional Reference

Long-Form Questions

Acknowledgements

Application Fee