Clinical Pastoral Education/Training Application

Please complete all the fields below. Please contact Ken Waddell by phone or email with any questions 706.217.2015 • [email protected]

Candidate’s Full Name:
First Middle Last
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone (home):
Phone (cell):
Email
Denomination/Faith Group:
Jurisdiction/District/Diocese/Conference/Assoc:
Ordained/Licensed/Appointed:
College: Degree/Date:
Seminary: Degree/Date:
Grad School: Degree/Date:
Prior CPE Date(s):
Center:
Supervisor:
Autobiographical Reflection: * Required
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.
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.
CPE/CPT Training:
What’s your understanding of Clinical Pastoral Education/Training and what do you hope to gain for your personal/professional development?
Curriculum Vitae:
Please provide a brief Curriculum Vitae that documents your education, training and work experiences.
File Upload:
Max. file size: 512 MB.
Please upload any pertinent documents.
File Upload:
Max. file size: 512 MB.
Please upload any pertinent documents.
File Upload:
Max. file size: 512 MB.
Please upload any pertinent documents.

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