Clinical Pastor Education (CPE) Application



Submit application at least 30 days prior start of semester. We need time to approve the application. CPE units start at a variety of times.

CEP Program Application Status
I have*

You must be accepted into a CPE program for final approval into P2553: Clinical Pastoral Education. You may begin the seminary approval process as soon as you have started the application to a CPE program. As soon as you receive the CPE approval letter, submit it and a copy of your CPE application to the supervising professor.

The CPE program is*

CPE Center Information

Address of CPE Center*


( )   -

CPE Program Affiliation*

The CPE Center has a Parent Institution*

CPE Supervisor Information

Mailing Address*


( )   -

Supervisor Certification Level*

Certifying Organization*

I agree to submit the documents listed below and to participate in a course review with the supervising professor at the end of the CPE unit.*

(1) The CPE unit list of activities (Individual Supervision, Group Supervision, Clinical Hours and Activities, Reading, and Writing Assignments); (2) The Learning Contract; (3) The-Mid-Unit Self-Evaluation; (4) The Final Self-Evaluation; (5) A Pastoral Care Report (verbatim); and (6) The Supervisor’s Final Evaluation of the Student.

Ministry Organization Information
Ministry Setting*

Check all that apply.

Student's Position Title*