Alberta Consortium for Supervised Pastoral Education (AC-SPE)

Clinical Pastoral Education (CPE) Programs

Application Form

NOTE: Forms such as this one can sometimes be problematic for users. The form is designed so the user can move from field to field by means of the “tab” or “down arrow” key, with mouse assist as may be helpful. If you would prefer to navigate this document without being limited to use of these keys, click “Developer” on the menu and unlock/click on the “Protect Form” icon (often looks like a padlock).

NAME:

ADDRESS:

PHONE: RESIDENCE: CELL or ALTERNATE:

E-MAIL: FAX:

FAITH GROUP:

CURRENT OCCUPATION:

Please indicate the program for which you are applying:

Program Type[1] (check one): CPE Unit Course-Based CPE Practicum

Program Timing[2] (check one): Summer Intensive Extended (Autumn to Spring)

Program Location[3] (check one): Calgary Edmonton

Start Program in the year: 2018 2019 2020

Where did you hear about the Alberta CPE program offerings (check all that apply):

CASC/ACSS Website Alberta Health Services Website

Theological College Faith group publication / poster

Word of mouth / personal referral Other (please describe)

The following documents must be submitted with your application, noting that incomplete applications will not be considered:

·  Current résumé or curriculum vitae.

·  An autobiographical statement, approximately 1000 words in length, indicating significant life experiences and how these have affectively impacted you. Include themes important to your spiritual, emotional, and psychological journey.

·  A description of a recent pastoral/spiritual care/service intervention. Include details regarding the setting, context, and individuals involved (taking care to protect confidentiality), your role in the intervention, and the outcome.

·  Copies of student and supervisor evaluations from all previous CPE courses that you have completed (if applicable).

·  If applicable please submit a transcript from the university or college which you have attended (most recent degree or diploma only)

·  A list of names of three references (see below).

Please respond to the following questions on a new page:

1.  Why are you applying for a Clinical Pastoral Education (CPE) program at this time?

2.  What are your overall personal and professional goals?

3.  Program expectations are that you will participate fully and consistently in all group aspects of the program, submit satisfactory written material to your Supervisor-Educator regularly and in a timely manner. You will also be asked to provide pastoral/spiritual care service including on-call (or its equivalency), worship leadership, etc., as requested by your assigned placement site and in keeping with your abilities as well as institutional policies. Given these expectations: How will you make time for this program?

4.  What kinds of support do you have in place to assist you in accommodating your course of study?

5.  Are you aware of any limitations that would prevent you from fully participating in and completing the CPE program?

The following documents must be submitted under separate cover:

Three letters of recommendation from the individuals you have listed below need to be received by the Intake CPE Supervisor-Educator within 10 days following the application deadline of the CPE program for which you are applying. References should speak to your professional or academic experiences and capabilities. One reference should be an official of your faith group. Personal references are unsuitable. Please note the people who are providing references on your behalf must use the form provided and submit the form directly to our office. Although the completed form may be accompanied by a formal letter of reference, the letter will not suffice as a recommendation without the completed form.

List of people submitting references:

NAME / PHONE NUMBER / RELATIONSHIP TO YOU

Screening Interview

After receiving your application you will be notified by the Intake CPE Supervisor-Educator that your materials have arrived and an application file has been opened in your name. After assessing your completed application file, including letters of reference, you will be contacted about whether or not a screening interview is to be scheduled. The aim of the interview is to explore your desire, fit and readiness to participate in the program. Should distance or other factors preclude a face-to-face interview (which is preferred), the interview may be done either by telephone or videoconference. This will be decided in discussion with you.

Registration

If you are chosen to be a participant in a CPE program, you will be given a ‘Letter of Acceptance/Offer’ signed by the CPE Certified/Provisional Supervisor-Educator(s). This is to be presented to the Registrar at either St. Stephen’s College in Edmonton (Course-Based CPE Practicum only), or Ambrose University College in Calgary (CPE Unit only) where you will be registered for the program. Note: Should you be offered a position within a CPE program (Unit or Course-Based), you will be required to provide personal health screening information and a current criminal records check, at your own expense, to the college where you are or will be enrolled.

Tuition

Tuition has been set at $2,400. This figure is calculated based on the cost of students’ completing 6 graduate academic credits; it also includes the cost of professional supervision. Tuition is to be paid to the theological college in which you register prior to the start of the program. Again: “CPE Unit” students register with Ambrose University in Calgary and “Course-Based CPE Practicum” students register with St. Stephen’s College in Edmonton. Credits completed through CPE programs may be transferred into other academic programs within Alberta, and beyond.

Correspondence

Please direct correspondence to the Alberta Consortium for Supervised Pastoral Education (AC-SPE) CPE Intake Supervisor in either southern or northern Alberta:

Rev. Dr. Philip Behman
Certified Supervisor-Educator
Intake CPE Supervisor, Calgary & southern Alberta
c/o Spiritual Care Services
Alberta Children's Hospital
2888 Shaganappi Trail NW
Calgary, AB T3B 6A8
Phone: (403) 955-7868
/ Dr. Darlene Pranke
Provisional Supervisor-Educator
Intake CPE Supervisor, Edmonton & northern Alberta
c/o St. Stephen’s College
University of Alberta Campus
8810 – 112 Street
Edmonton, AB T6G 2J6
Phone: (587) 785-1536

2

[1] There are two types of CPE Program offerings in Alberta. CPE “Unit” teaching days contain 3 seminars (including Didactic/Theory). Course-Based CPE “Practicum” teaching days contain 2 seminars (with Didactic/Theory being gained through academic courses, workshops, etc.).

[2] There are two time periods for CPE Program offerings in Alberta: Full-time summer intensive (5 days/week for 11 weeks), and Part-Time extended (2.5 days/week for 28 weeks). [Note: Course-Based CPE Practicum offerings occur only in Edmonton at this time.]

[3] CPE Programs are currently run out of Calgary and Edmonton