www.cpe-toronto.ca
Clinical Psychospiritual Education (CPE) 
ADVANCED Application
Important: Download this form and save a copy of your application before submitting it by email.
Personal Information						Date: ____________
Last Name		
First Name:		
Street Address:		
City/Town:		
Postal Code:		
Phone:				
Email Address:		
University of Toronto student number:		

Current Student Status
All students must be enrolled in a degree program with a University or College that has a placement agreement with the teaching hospital. Fees will be paid by the student to their college through the registration system. Proof of registration is required to begin CPE. A student must apply to the teaching hospital directly, appear for the interview, and receive a letter of offer from the teaching hospital before enrolling in their educational institution’s registration system. 

Details of Current Educational Program Enrollment 
Which educational institution are you currently enrolled in? 		
Theological School:		
Degree:		
Graduation Year:		

Previous Education
In this section, outline your post-secondary education, including your university degree, theological degree (if applicable), and other relevant degrees.
College/University:		
Degree Received:		
Graduation Year:		

College/University:		
Degree Received:		
Graduation Year:		

College/University:		
Degree Received:		
Graduation Year:		

Past Work Experience (or attach a Resume)
Job title/description	Company/location	Employment dates	

			

Faith Group Information
Spiritual Association
Faith group/religion:		
Describe your current and past involvement in your spiritual community, i.e.  congregation, house church, religious order, synagogue, Mosque, Temple,
If you do not have a spiritual community, briefly describe your spiritual journey:		

Course Information
List the Teaching Centre to which you are applying in order of preference and the dates for the specific unit. You are encouraged to apply to more than one Centre if your first choice is unavailable.
Type of CPE Unit (Check One) 
Advanced Unit 1	Advanced Unit 2	

First Choice
Teaching Centre:		
Dates: (Day/Month/Year)- (Day/Month/Year)		
Note: It may not be possible to place you in a specific location in multi-location centres.
Second Choice
Teaching Centre:		
Dates: (Day/Month/Year)- (Day/Month/Year)		
Note: It may not be possible to place you in a specific location in multi-location centres.
List past Clinical Psychospiritual Education (CPE) or Psychospiritual Therapy Education (PTE) units 
Students applying for advanced units must include a copy of their self-evaluation and their supervisor’s evaluation for Basic Units 1 and 2.
CPE/PTE Unit #1
Institution/Centre:		
Supervisor:		
Year Completed:		

CPE/PTE Unit #2
Institution/Centre:		
Supervisor:		
Year Completed:		

CPE/PTE Unit #3
Institution/Centre:		
Supervisor:		
Year Completed:		

Previous CPE/PTE units not completed.
Institution/Centre:		
Supervisor:		
Date:		

References
Please enter the names and contact information for three references: two persons to whom you were responsible as a student, employee, or volunteer, and one from a spiritual leader of your faith group. 

Reference #1
Name:		
Street Address:		
City/Town:		
Postal Code:		
Country:		
Phone:				
Email Address:		
Position:		

Reference #2
Name:		
Street Address:		
City/Town:		
Postal Code:		
Country:		
Phone:				
Email Address:		
Position:		

Reference #3
Name:		
Street Address:		
City/Town:		
Postal Code:		
Country:		
Phone:				
Email Address:		
Position:		

The Following Essays and a Resume must be included in the completed application:
 (See CASC Manual; Chapter 2: Education)
1.	Autobiography (1000 - 1500 words):
What do you know about yourself? The Triad: My history – Me (my spirituality) – Me in my spiritual care practice (How is that acted out in my practice). 
Using your personal life story (i.e., personal, family, educational and vocational history, including SPE history), describe how you have integrated this into your personal and professional identity and your practice of spiritual care. 
Option: Using yourself as the subject write your autobiography based on one of the personality theories/ paradigms highlighting how this impacts the way you provide spiritual care. 

2.	Paper (1000 - 1500 words) highlighting beliefs as they pertain to the Work of Spiritual Care, including: 
Give examples of how the expression of your faith, beliefs, values, and spirituality are expressed in your spiritual care work. 
Give examples of a deepening self-awareness of your internal belief systems. What do you believe in the context of experience? 
Include in your discussion appropriate competencies as they apply. 

3.	Paper (1000 - 1500 words) highlighting how the experience of SPE has informed your Work of Spiritual Care, including: 
What have been the learning threads throughout your Basic SPE? How do these threads relate to your belief system, your spirituality and your spiritual caregiving? 
Give examples of how your clinical experience has impacted and informed how you provide Spiritual Care. 
Give examples of how the SPE educational process (i.e., supervision, group work, etc.) and how other education processes have informed/ influenced the development of your spiritual care work. 
Include a discussion of SPE spiritual care and counselling competencies as they apply. 

4.	Paper (1000 - 1500 words) demonstrating your readiness to learn at the Advanced level of SPE with reference to CASC/ACSS Competencies, including: 
Give examples of how you utilized the evaluation process (i.e., written and group presentation) for a synthesis of learning and growth. 
Give examples of your ability and desire to utilize SPE education for the benefit of your work and for how other educational processes have informed your work. 
Give examples of how you have grown personally and professionally in the SPE process. What goals have you set for yourself that will demonstrate that you are able to work at the next competency level? 

Submit your Application 
I confirm that, to the best of my knowledge, all the information in this application is correct.
Name:		
Signature: 		
Email:		
Telephone: 		
Date Submitted:
(Day/Month/Year)		

Please note:
•	Acceptance into the advanced CPE program requires membership in CASC – Please go to https://www.spiritualcare.ca/benefits--categories.html  to apply for membership. Student membership fees are currently $90.00 per year. You will not be able to receive your certificate unless you have paid your membership!
•	You will be required to adhere to the admission policies of the Centre, e.g., Medical profile, current immunization records, health and safety training, police check, etc.
•	
Privacy Policy

The CASC Supervisors of the GTA (CSGTA) are committed to maintaining your trust and confidence. The following privacy policy is designed to protect the personal information you provide on our website. Your right to privacy is fundamental to us.
Our website aims to educate and inform our students, potential students, applicants, and the general public about the programs offered by CSGTA. When you visit this site and access information, you are anonymous. We do not require you to provide personal information to view it.
However, when you apply for one of CSGTA's programs, we ask for detailed information from our applicants. Given the sensitive nature of clinical psychospiritual education, CSGTA is responsible for protecting the students' potential clients by thoroughly reviewing the qualifications, experience, and gifts of each person applying to one of our programs. We will also endeavour to protect the confidentiality of the information applicants provide. Therefore, we will not share this information with anyone not involved in the application approval process.
We will not use the applicant's e-mail or contact information other than contacting the applicant regarding their application status or, after registration, to contact students regarding matters directly related to their participation in CPE programs.

More information on each teaching centre and CPE supervisors, including telephone numbers, may be found at www.cpe-toronto.ca