Supervisory Candidate (Step II-Capstone Assignment)
Date
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Month
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Day
Year
Date
Supervisory Candidate
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First Name
Last Name
Supervisory Candidate Email
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Training Supervisor-Educator
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First Name
Last Name
Training Supervisor-Educator's Email
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Requested Month for Certification Interview
February
May
August
November
Check the appropriate answer.
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Rows
YES
NO
I organized, managed, and supervised a solo course of CPE.
I interviewed, accepted or declined students for this course.
I prepared a written narrative for each videotape, demonstrating an understanding of the students' cultural dynamics, learning styles, religious history, and psychosocial development patterns.
I prepared a final evaluation for each of the students.
I remained in consultation with my training supervisor-educator throughout this course.
I participated in one of the supervisory candidate connection groups.
Upload the 15-minute (maximum) Segments of Individual and Group Supervision. (Only videotapes from this current course as acceptable).
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Upload Narratives for Each Individual and Group Video.
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Upload Student and Supervisor-Educator's Final Evaluations for the Solo Course.
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Upload a copy of your course syllabus.
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I acknowledge the attached materials are my own and I am prepared to meet the CPEI Certification Committee.
Yes
No
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