Hybrid Field Education & Clinical Pastoral Education at Union

Application Face Sheet & Instructions

Please complete all required fields and click the submit button.

READ CAREFULLY AND RESPOND TO EACH OF THE FOLLOWING:

IMPORTANT NOTE: Create your responses in a Word doc then cut and paste them into the form. The form can time out after a couple of days and we do not want you to lose your work.

If you have any questions about this form and how to complete it, contact Joanna Katz at jkatz@uts.columbia.edu


Student Name*
I have taken or am currently enrolled in the prerequisite course PS 110.*
I have taken or am currently enrolled in the strongly recommended course PS 101*

Submit Five Essays as part of your application. (Aim for 4-5 pages each for the first two essays, the others approximately 2 pages.)

Include a response to each section below.

1. 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 social relationships.

Upload "Life" Essay*
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2. 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 conversions, your call to ministry/rabbinate, religious experiences, and significant persons and events that have impacted, or continue to impact, your spiritual growth and development.

Upload "Spiritual Growth & Dev." Essay*
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3. 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. A current resume will suffice.
Upload "Vocational" Essay*
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4. Account of "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 bried evaluative commentary on what you did and how you believe you were able to help. Note! Read 4A before you begin your response.

4. If you have had prior and RECENT CPE, please attach a copy of a verbatim as your "helping incident" with your own notes on how and what you learned from sharing this verbatim with your supervisor and/or peers. If you have had CPE more than two years ago, include a recent helping incident, written up in a verbatim format. If possible, include feedback from current pastoral colleagues and/or administrative supervisor.*
Upload "Helping Incident" Essay*
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5. Your impressions of Clinical Pastoral Education.

Indicate, for example, what you believe or imagine CPE to be. Indicate if CPE is being required of you. What are your learning goals or issues of which you are aware and would like to address in CPE. Finally, indicate how CPE may be able to help you meet needs generated by your ministry or call to ministry. Note! Read 5A before you begin your response. Note!

5A. If you have had prior CPE, please 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.
Upload "Impressions of CPE" Essay*
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6. An applicant with prior CPE should attach all previous final evaluations (your own and your supervisor's). Your typed signature below indicates you permission for previous CPE centers to release your evaluations for purposes of this application process.*
Upload previous Final CPE Evaluations
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7. You are required to complete an admissions interview with Rabbi Joanna Katz.*
8. When you submit your application you will automatically be emailed a copy of your submission. Print and retain a completed application and bring it with you to the interview for CPE.*

Application for Units of CPE

Hybrid Field Education and Clinical Pastoral Education at Union

Please complete all required fields.

Name*
Address*
Permanent Address*
U.S. Citizen or Permanent Resident*
Date*
Projected Date*
Date
Date

CPE Center: JTS/UTS

Have you ever been convicted or pled no to a misdemeanor, a felony, or other crime?*

References

Reference forms can be accessed at the following link. REFERENCE FORM


Academic Reference*
Address*
Denominational Reference*
Address*
Personal Reference*
Address

Signature

I certify that all information in this application is factually true, complete and honestly presented. I understand that I may be subjec to disciplinary action, including admission revocation or program explulsion, should the information I've certified be false. I hereby give permission to the ACPE center to which I am applying to accesss my CPE evaluations and contact previous supervisory personnel about matters pertaining to this current application, and I consent for those contacted to provide information sought. I verify that if sending in this application electronically it constitutes my electronic signature.

Date

Submit

Click the "Submit Form" button at the bottom of the page. The applicant will receive an email with a transcript of the submitted form.

CPE is not a trademark and variously accredited programs are advertised and offered.

The Jewish Theological Seminary, www.jtsa.edu/Academics/Center_for_Pastoral_Educati...

Association for Clinical Pastoral Education, Inc., www.acpe.edu

FOR OFFICE ONLY

Field Education Office Approval
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