** Please note that a $10.00 non-refundable processing fee must accompany this application form. Payment must by made by cheque or money order made payable to SIPE. **
The Program for which you are applying:
Spring – intensive: ___________; Winter – extended: ____________
Preferred Site (Swan Valley, St. Paul’s Hospital, LutherCare): __________________
Full Name: _______________________________________________
Date of Birth: __________________
Present Mailing Address: ___________________________________________________________________
E-mail address: ____________________________________________________________________________
Present Telephone Number: _________________________________________________________________
Denominational Affiliation (if applicable):
Present Position: ___________________________________________________________________________
Education: Specialization: Degree/ Diploma:
College: _______________________ _______________________ ___________________
Seminary: _____________________ _______________________ ___________________
Other: ________________________ _______________________ ___________________
Previous Supervised Pastoral Education: (including Dates, Centres and names of Supervisors):
Other Significant Education and/ or Experiences: ________________________________________________
Recent Positions Held: Place: Position: Dates:
References: Please include the Name, Address, and Telephone No. – Provide each reference with the reference form found on the website and have them send it directly to the Registrar
Please attach to this application your type written response to the following: (total pages not to exceed 8 pages):
1. A reasonably full account of your life, including important events and relationships, and the impact of these relationships on your development.
2. A description of your relationship to significant others at this time, and the issues and transitions in your life which are important.
3. A description of the development of your spiritual life, and your current spiritual care aspirations.
4. Your impression of CPE, and your expectations of the program to which you are applying.
5. Describe an incident in which you were called upon to help someone; the nature of the request and how you attempted to help.
6. Copies of your own evaluation and that of your Supervisor of previous CPE Units (if any).
Signature of Applicant
Please forward the completed application with payment covering the processing fee to:
Margaret McCallum , Spiritual Care Educator
email address: [email protected]