Clinical Pastoral Education Application Application for Clinical Pastoral Education

Application for Clinical Pastoral Education
Email
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Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Denomination/Faith Group Affiliation
Jurisdiction/District/Diocese/Conference/Assoc:
Jurisdiction Authority (name/title)
Local Church and Ministry Position
Licensure
EDUCATIONAL BACKGROUND
College/University Name Degree/Date:
Seminary Name Degree/Date:
Grad Schl: Degree/Date:
Prior CPE Dates (include center, and supervisor name and contact info)
REFERENCE AND BACKGROUND
Academic Reference (Name/Title/Email/Phone)
Denominational Reference (Name/Title/Email/Phone)
Personal Reference Name/Title/Email/Phone)
What CPE unit are you pursuing? *
UPLOAD YOUR RESUME

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ESSAY QUESTIONS

Please answer the six below essay questions, in a separate Word or PDF, and upload your response below. Read the questions fully, before starting the essay.
ESSAY QUESTION 1 Please complete the following question and upload it here. A reasonably full 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. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.

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ESSAY QUESTION 2 A description of 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 call to ministry, religious experiences, and significant persons and events that have impacted, or continue to impact, your spiritual growth and development. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.

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ESSAY QUESTION 3 A description of your work (vocational) history. Include a chronological list of jobs/positions/dates of employment and a brief statement about your current employment and work relationships. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.

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ESSAY QUESTION 4 An account of 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 current pastoral colleagues and/or administrative supervisor. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.

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ESSAY QUESTION 5 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. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.

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ESSAY QUESTION 6 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. You will notice that there are no instructions pertaining to word count, per question. This is up to your discretion.File Upload

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THE SMALL PRINT AGREEMENT
An applicant with prior CPE should attach all previous self and supervisory evaluations and your signature below indicates you give permission for your previous CPE centers to release your evaluations for purposes of this application process.*

YESNO
I understand I can only miss 2 classes, otherwise I will be asked to withdraw from the course, possibly losing my tuition.*

YESNO
I understand that portions of our Supervision (meeting between myself and supervisor) may be recorded for the Supervisor in Training program.*

YESNO
I agree to pay the full tuition amount in full, or in three installments on or before April 14, 2024*

YESNO
I agree to attend the orientation (for first time students with Kumar) on January 9, 2024, at 6:00pm – 8:00pm EST*

YESNO
LEAVE A MESSAGE FOR KUMAR
QUESTION OR COMMENT FOR KUMAR
NEXT STEPS:
Once completed, submit the documents with your non-refundable application fee:
1. Application form
2. Essay questions
3. Resume
4. Application fee: $100
PAYMENT INFORMATION:
You can send your non-refundable deposit to secure your spot (upon approval) by any payment method below. The preferred payment is Paypal.

Venmo: @dixitmediagroup (last four digits of phone 5300)

CashApp: @kumardixit

Zelle: RajkumarDixit

Paypal: wonderingaboutgod@gmail.com
HOW TO REACH KUMAR:
Feel free to email me at conciergeminister@gmail.com or text me at (202) 599-6626
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Application for Clinical Pastoral Education

EDUCATIONAL BACKGROUND

REFERENCE AND BACKGROUND

ESSAY QUESTIONS

THE SMALL PRINT AGREEMENT

LEAVE A MESSAGE FOR KUMAR

NEXT STEPS:

PAYMENT INFORMATION:

HOW TO REACH KUMAR: