Supervisory Education Application

Please respond to each of the following items

Please complete the form below and submit. Read instructions carefully before submitting.

If you wish to pay your application fee with a credit card, do so before completing the application by clicking on the Pay Now button below. Then return to the application, complete and hit the submit button. You may also pay your application fee via check made out and sent to the information at the bottom of this application. No applications will be processed without the application fee paid.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How many units of CPE have you completed? Include where you took the units and the name and contact information of your CPE supervisor

Highest Degree earned. Include where you earned your degree.

A Masters degree or its equivalent is required to enter Supervisory Education. If you are applying for equivalency please describe curriculum or experience. You may be asked for supplemental documentation.

Are you licensed or ordained clergy or in a licensed ecclesiastic position in your faith organization?

Yes

Are you Ecclesiastically Endorsed for chaplaincy or pastoral counseling by your faith organization?

1. 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.

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 spiritual awakenings/revelations, your call to ministry, and significant persons and events that have impacted, or continue to impact, your spiritual growth and development.

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.

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 Case Study as your 'helping incident' and add to the verbatim your own notes on how and what you learned from sharing this Case Study 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 Case Study format. If possible, include feedback from current pastoral colleagues and/or administrative supervisor.

5. What Did You Learn in Clinical Pastoral Education? Indicate the most significant learning experience you had during CPE. State how you have continued to use the clinical method since your previous experience. 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 SEF/SIT will help you to attain or address these learning goals and issues.

6. Why Do You Want to Become a CPE Supervisor Please explain what is motivating you to apply for Supervisory training. Be specific. What do you expect to accomplish through this Supervisory program.

7. You are required to complete an admissions interview with a CSCPF /CPSPCPE supervisor or a person approved by Spiritual Living Center for Education & Training (SLCET). You will also need to be interviewed by the Learning Center’s CSCPF Community and/or CPSP Chapter.

8. You will need to send all previous self and supervisory evaluations and 3 letters of recommendation (include contact information of the authors) to apply@slcet.org

I understand and will email the requested evaluations to apply@slcet.org

9. Have you ever been convicted of a felony?

(This will not necessarily prevent you being accepted into SEF with SLCET)

Yes

10. Are you a Board Certified Clinical Chaplain or Pastoral/Spiritual Counselor? If so, when and by what certifying body? (CSCPF, CPSP, APC etc.)

11. If you are not yet board certified clinical chaplain, be aware that you are required to be before completion of your Supervisory Training Program. Also if you have not yet been certified please provide a written statement on how the Standards and Competencies of Clinical Chaplaincy in CSCPF or CPSP have been met.

By checking yes below, I confirm that all information given in this application is true and is verifiable. I also understand that this application will not be processed until a non-refundable application fee of $125.00 is paid. You may send a check for that amount made out to SLCET at 573 Park Point Dr., Golden, CO 80401, ATTENTION: Rev. Paula Belleggie or you may with a credit card iva the Pay Now button located at the top of this application.

Yes