Application For Congregation-Based Clinical Pastoral Education

 

             This is where you can download the application For Congregation-Based Clinical Pastoral Education of WNY for the Buffalo, NY & Jamestown, NY & Rochester, NY areas.

 

RETURN TO :
       Rev. Robert C. Spilman
363 Darwin Drive
Amherst, NY 14226
 

 

* Be sure to include the application fee of $40 payable to : "Samaritan Pastoral Counseling Center” or “SPCC.”

Download Application (.doc format)

 
Submit Application Online
 (payment must be received separately at this time) 

 

Your information will never be sold to others and will only be used for the pastoral education process.

* = Required Information
Basic Information:
First Name*  
Last Name*
Street Address*
City*
State*
Zip Code*
Telephone*
Cell
E-Mail*
Date of Birth
Social Security Number

 

Congregation Information:
Present Congregation
Congregation Street Address
Congregation City
Congregation State
Congregation Zip Code
Congregation Telephone
Congregation E-mail

 

Education:
College
College Dates
College Major
Seminary
Seminary Dates
Major
Ordained Date
Denomination
Length of Pastoral Experience

 

Questions:

1.      A reasonably full account of your life including important events and relationships with persons, especially family of origin, describing the shaping of your identity in the family.*

2.      A discussion of the development of your spiritual life including faith experiences, your participation in the life of the church, and your decision to enter the ministry.*

3.      Describe how any significant challenge or loss in your life has impacted your awareness of self or others.  Include an assessment of your current health and wellbeing.*

4.      State what you hope to learn in Congregation-Based CPE including your impression of and expectation for Clinical Pastoral Education.*

5.      List previous CPE experience, if any, and provide copies of evaluations, if available.

Anything else you want to tell us?

Select CPE Unit Applying for *
(1) Aug.—Nov. (Jamestown)
(2) Oct.—Feb. (Buffalo)
(3) March—June (Rochester)

 

Digital Signature of Applicant*
Date*

*Application fee of $40 payable to: “Samaritan Pastoral Counseling Center” or “SPCC.” which at this time must be sent separately, a copy of your answers will be displayed if you wish to send a copy with the payment, along with a copy to the supplied e-mail. be sure to include at least your name and address with payment.