Course Application Application for Enrolment CPE Unit: (to which this application relates)CPE Centre*Please select.....The Princess Alexandra HospitalThe Prince Charles Hospital/St Vincent's Private Hospital NorthsideGold Coast University HospitalLogan HospitalSunshine Coast University HospitalToowoomba HospitalRural Darling DownsHervey Bay/BundabergTownsville Mater HospitalMt IsaMostly onlineLevel* Foundational Advanced Mode* Part-time Full-time Commencement Date* DD slash MM slash YYYY Supervisor/s*Please select....Cathy BrownAnnie BakerApplicant's personal detailsName* First Last Title*Please select.....MrMrsMsMissRevPastorSisterFatherOtherAddress* Street Address City ZIP / Postal Code Email* Phone - home*Phone - workPhone - mobile*Date of birth* MM slash DD slash YYYY Place of birth* Marital status* Spouse/Partner* Children (names and ages)*Church AffiliationDenomination/Faith Affiliation* Local church/parish Address Street Address City ZIP / Postal Code Name of parish priest/minister/leader PhoneAccreditation for MinistryName of religious body Location Date DD slash MM slash YYYY Tertiary EducationCourse #1 Institution #1 Length #1 Date of award #1 DD slash MM slash YYYY Course #2 Institution #2 Length #2 Date of award #2 DD slash MM slash YYYY Course #3 Institution #3 Length #3 Date of award #3 DD slash MM slash YYYY Theological Education (if not cited above)Course Institution Length Date of award DD slash MM slash YYYY Other TrainingCourse Institution Length Date of award DD slash MM slash YYYY CPE Units already undertaken:Centre Location Completion date DD slash MM slash YYYY Supervisor Details of any other CPE applications previously declined or currently being processedPast Experience of MinistryDescription Location Dates Hrs/week Present Ministry/Pastoral WorkDescription Location Dates Hrs/week Present Pastoral Responsibilities/Roles: (give details)Reasons for lodging this application: (your expectations and goals)Other Information: (considered relevant to this application)Referees: (three required, one from present or recent employment)#1 Name* #1 Address* #1 Phone* #2 Name* #2 Address* #2 Phone* #3 Name* #3 Address* #3 Phone* Autobiographical Statement – giving an account of your life, including emotional, social and spiritual development, relationships with significant others and important events and experiences. (1500 words MINIMUM)*A description and evaluation of a recent helping incident in which you were personally involved. (500 words approximately)*A statement of your learning goals and expectations for this unit. (250 words approximately)*Documents to accompany application form:Documents to be emailed to info@qicpe.com to accompany application A Recent Photograph A statement from your employer endorsing your application (if applicable) Supervisor's final evaluation report of last CPE unit undertaken (if applicable) $50 Application and Processing Fee (non-refundable) Payment method*Credit Card on QICPE website ($51)Direct Deposit to QICPE Inc, BSB: 034072, A/C No: 186321Cheque posted to QICPE Inc, PO Box 37, EVERTON PARK Qld 4053Deposit at Westpac bank: QICPE Inc, BSB: 034072, A/C No: 186321Application and Processing fee is required before submitting this application.Permission for restricted access for my contact details:As part of my application, I give my permission for my name, mobile number and email address to be accessed by the QICPE Secretary and Treasurer for the purposes of facilitating official QICPE processes (e.g. invoicing, membership matters, invitations to QICPE functions etc.)* Yes Acknowledgment of Admission Process and Demands of CPE ProgrammeAn admission interview is required of all CPE applicants and this will be arranged for you should your written application be successful. Interviews are conducted by the CPE Centre Director/Supervisor and another CPE Supervisor or Co-ordinator from the Clinical Placement Site. Areas for discussion at this interview may include one or more of the following: • An exploration of the written materials included in the application. • Motivation for participation in CPE at this time. • Learning goals for CPE. • Understanding of pastoral ministry and spirituality in your prac placement environment. • Perception of your pastoral strengths and limitations. • Perception of life events which might influence learning in your prac context. • Exploration of your emotional responses to the CPE interview process. • Practical matters concerning the CPE programme. • Criminal and health screening requirements. N.B. Being granted an interview does NOT guarantee being offered a place in a course. Demands of the CPE Programme. The CPE programme requires an intentional commitment from participants, in both time and emotional investment and is not suitable for everyone. The pastoral care of others and CPE group interactions can be challenging, and reflection on those encounters may be confronting. The discipline of writing up journals, case studies and pastoral encounter reviews enhances personal integration which makes the CPE program a demanding but enriching process. Students who are new to hospital or healthcare settings or multi-faith and multi-cultural settings may find challenges confronting. CPE is also often reported as one of the most rewarding adult education courses taken by participants. Participants enrolling in a 20-week part-time CPE should expect to commit at least 20 hours per week to CPE. A 35-week course requires an 11 hour/week commitment. A 40 hours per week commitment is required for full-time courses. These times include CPE group participation, implementing learnings in a practicum placement and time required to complete the reading and written components of the course. I acknowledge I have read the above information.* Yes To apply for enrolment, please complete the following details:
