CPM Form 4: Report on Consultation

CPM Form 4: Report on Consultation

PC(USA) Form; Revised December 2011
Date of consultation

MonthDayYear
Name of inquirer/candidate*

First NameMiddle NameLast Name
Continuation of Preparation Phase
After reviewing this consultation report, the commission of Pittsburgh Presbytery declares that*
(first name)
continuednot to be continued
in the *
Signature of the commission moderator

______________________________________________________________________________

Date__________________________________________________________________________
Agreement on Future Work Areas
We have jointly reviewed the areas of growth since the last consultation and have agreed to the growth objectives for the future, as reported below.
Name of care team member*

First NameLast Name
Name of care team member

First NameLast Name
Signature of the commission moderator

______________________________________________________________________________

Date__________________________________________________________________________
Indicate the stage of theological education for which this report applies:*
1. Review of growth since the last consultation
A. In the area of education for ministry*
B. In the area of spiritual development*
C. In the area of interpersonal relations*
D. In the area of personal growth*
E. in the area of professional development*
2. Growth objectives agreed for future
A. In the area of education for ministry*
B. In the area of spiritual development*
C. In the area of interpersonal relations*
D. in the area of personal growth*
E. In the area of professional development*
By signing this document, I attest the individuals named above are aware of and fully agree with the content.*
Date

MonthDayYear
Should be Empty:

CPM Form 4: Report on Consultation

Continuation of Preparation Phase

Agreement on Future Work Areas

1. Review of growth since the last consultation

2. Growth objectives agreed for future