Course ApplicationApplication for EnrolmentQld ResidencyI am a resident of Qld*Please select.....YesNoANZACPE affiliated CPE courses are offered in each State and Territory of Australia and in New Zealand. It is valid for people to apply for CPE outside of the State in which they reside, however QICPE would like to ensure that applicants are aware of the local CPE options as well. Please see the following websites for information about CPE in your area. New Zealand https://www.cpe-nz.org.nz NSW https://nswccpe.edu.au Victoria https://www.asacpev.org.au Tasmania http://www.taspe.com.au Western Australia https://www.acpewa.org South Australia and Northern Territory https://santacpe.com/santacpe/If you are applying for a QICPE CPE course from outside of Qld, please give reasons:CPE Unit: (to which this application relates)CPE Centre*Please select.....Mostly onlineThe Prince Charles Hospital/St Vincent's Private Hospital NorthsideToowoomba HospitalRural Darling DownsHervey Bay/BundabergTownsville Mater HospitalSunshine Coast University HospitalThe Princess Alexandra HospitalGold Coast University HospitalLogan HospitalMt IsaLevel* Foundational Advanced (you must have CPE supervisor approval to enrol in Advanced Course)Mode* Part-time Full-time Mostly onlineCommencement 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's name*Children (names and ages)*Spiritual AffiliationDenomination/Faith Affiliation*Local place of WorshipAddress Street Address City ZIP / Postal Code Name of parish priest/minister/leader/Guru/Master*PhoneAccreditation for MinistryOrdination, professional/commissioningName of religious bodyLocationDate DD slash MM slash YYYY Tertiary EducationMost recent firstCourse #1Institution #1Length #1Date of award #1 DD slash MM slash YYYY Course #2Institution #2Length #2Date of award #2 DD slash MM slash YYYY Course #3Institution #3Length #3Date of award #3 DD slash MM slash YYYY Theological/Spiritual Education (if not cited above)CourseInstitutionLengthDate of award DD slash MM slash YYYY Other TrainingIf not cited aboveCourseInstitutionLengthDate of award DD slash MM slash YYYY CPE Units already undertaken:LocationCompletion date DD slash MM slash YYYY SupervisorDetails of any other CPE applications previously declined or currently being processedPast Experience of MinistryDescriptionLocationDatesHrs/weekPresent Ministry/Pastoral WorkDescriptionLocationDatesHrs/weekPresent Pastoral Responsibilities/Roles: (give details)Reasons for lodging this application:Other Information: (considered relevant to this application)Referees: (three required, one from present or recent employment)#1 Name*Relationship to you*#1 Phone*#2 Name*Relationship to you*#2 Phone*#3 Name*Relationship to you*#3 Phone*Autobiographical Account (1500 words MINIMUM)A reflective and reasonably full account of your life, including important events and relationships, and the effects of these significant relationships and events on your emotional, social and spiritual development.*Recent Helping Incident (approximately 500 words)Write a description and evaluation of a recent helping incident in which you were personally involved – the nature of the request, your understanding of the request, and your response to the request.*Learning Goals and Expectations (approximately 250 words)Your current understanding of CPE, your learning goals and expectations for this programme, and how you hope to use your learning in your ongoing work and professional development.*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) Evidence of payment of processing fee of $50. See below.$50 Application and Processing Fee (non-refundable) Payment method*Please choose from Drop Down list: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.)* YesAcknowledgment 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:
