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Clinical Pastoral Education Application

Clinical Pastoral Education Application

Thank you for your interest in the Saint Raphael’s Clinical Pastoral Education (CPE) program.  Please complete the form below. For Questions 1 thru 5, you may copy and paste your essay answers into the boxes.

When you hit “Submit,” you will receive a confirmation of receipt.

NOTE: CPE Residency usually requires an in-person interview as part of the admission process.

Downloads:

References Form

For Roman Catholic Applicants Only – Letter for Ques. # 7

* Indicates required information
Date *    (mm/dd/yyyy)
Application is for (time period): * 

If Other, please specify:

For what year? 
Earliest date you can begin 
Name * 
Email Address 
Street Address 1 * 
Street Address 2 
City * 
State * 
Zip * 
Cell or Daytime Phone * 
Denomination/Faith * 
Education – College 
Association: 



If Other, please specify:

Undergraduate Degree/Date * 
Education – Seminary/Date * 
Education – Graduate 
Graduate Degree/Date 
Previous Clinical Pastoral Education * 
Please indicate names from whom you’ll seek academic, denominational & personal references. Send the reference form at the top of this page to each one. You can copy and paste the form into your email to each person. * 
For essay ques 1-5, remember they represent an opportunity for potential supervisors to meet you. Please devote several pages to each to fully articulate your responses. You can paste essays into each question window. 
1. Provide a reasonably full acount of your life, including important events, relationships with people important to you, family of origin, current family and important social relationships. * 
2. Describe the development of your religious faith, relationships that affected it, your belief systems, call to ministry, significant people or events that impacted your spiritual growth. * 
3. Describe your work (vocation) history, including a chronological list of positions/dates, and a statement about current work relationships. * 
4. Describe an incident where you were called to help someone/nature of request/problem, what you did, and evaluation. If you received feedback, please summarize what you learned. If you took previous CPE, this material should be submitted verbatim. * 
5. Describe your impression of Clinical Pastoral Education, your educational goals and how this training will be used to meet them in your ministry. Is CPE required for you? * 
6. Application fee is $25.00 

If Other, please specify:

7. Roman Catholic clergy applying to USCCB accredited centers must initiate contact between current bishop & archdiocese where the prospective training is located toward obtaining faculties. Please download the letter (see intro to this form). 
8a. Interview * 

If Other, please specify:

8 b. Those with previous CPE, please provide both your supervior’s and your own evaluations. 
8c. If written summary is not availble, please provide name of interviewer, address, date, and phone 
For those with previous CPE, describe your personal and professional goals 
Check a permission box * 

If Other, please specify:

 

Page last updated on Jul. 22, 2010