CPEI Supervisor Certification Application

CPEI CPE Supervisor-Educator Certification Application

Supervisory Candidates Will Complete This Form After Successfully Meeting a Certification Committee for Approval as Supervisor-Educator.
Name*

First NameLast Name
DATE
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

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Postal / Zip Code
CPE Associate Supervisor-Educator- Board Certified Associate Chaplain (BCAC) or Board Certified Chaplain), a bachelor's degree and a graduate degree of at least 36 hours, preferably in theology or a related discipline. The Certificate of CPE (1600 hours) and Supervisory Education (1600 hours). Qualified to supervise the Certificate of CPE (1600 hours).CPE Supervisor-Educator- Board Certified Chaplain (BCC), graduate degree of 72 hours in theology or related discipline. The Certificate of CPE (1600 hours) and Supervisory Education (1600 hours). Qualified to supervise the Certificate of CPE (1600 hours).CPE Training Supervisor-Educator- graduate degree with at least 72 graduate hours in theology or related discipline, the Certificate of CPE (1600 hours) and the Certificate in Supervisory Education (1600 hours), and the completion of CPEI learning modules TSEC 2000-2003. Qualified to supervise the Certificate of CPE and the Certificate of Supervisory Education.Reciprocity-Certified CPE Supervisor or Training Supervisor with another recognized pastoral cognate group. Required to complete CPEI Learning modules FOC 3000 Supervisor-Educator Emeritus. This category applies to individuals who have held certification and as a CPE Supervisor.Supervisor-Emeritus.
Attach Copies (Required of all but Supervisor-Educator Emeritus):
- Certificate of Certification
- Graduate Academic Transcripts.
- Current Resume/CV
- Religious Endorsing Agency Approval Letter (Local Churches Cannot supply this. Here is a link to approved endorsers. https://prhome.defense.gov/M-RA/MPP/AFCB/Endorsements/   
- Evidence of background check -THE BASIC CHECK IS ACCEPTABLE https://clearchecks.com/order-reporthttps://clearchecks.com/order-report
Certificate of Certification*

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Graduate Academic Transcripts*

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Current Resume/CV*

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Faith Group Endorsement*

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Background Check*

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Payment is Required Unless an Invoice is Needed.

CPE Associate Supervisor-Educator

$249.00

CPE Supervisor-Educator

$249.00

CPE Training Supervisor-Educator

$249.00

Supervisor-Educator Emeritus

$249.00

Total

$0.00

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CPEI CPE Supervisor-Educator Certification Application