Clinical Pastoral Education Training Institute of North America
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Clinical Pastoral Education Training Institute of North America, CPE, Clergy, and Chaplain Certification and Training
Proudly not-for-profit.      Our team has served clergy and spiritual workers for 49years          
EMAIL          863-441-3000
CPEti
My preferred title is: Mr., Mrs., Ms, Rev., Fr., Rabbi, Dr., Sister, Bro., Chaplain, Elder, Deacon, etc.
Name: First, Middle Initial, Last Name (Jr., etc.
Email Address:
Street Number and Name
City / Town
ZIP or Postal Code
THE FOLLOWING FORM IS AN IMPORTANT FIRST STEP TO BE TAKEN BEFORE BEING CONSIDERED FOR POSSIBLE CPEti ENROLLMENT. I AGREE THAT MY ANSWERS ARE ACCURATE TO THE BEST OF MY KNOWLEDGE Yes
No
Number of CPE Units that I would like to earn if enrolled in this program 1
2
3
More than 3
I have carefully read the FAQs at http://www.cpeti.org/FAQs.html. Yes
No
I understand and agree to the tuition donation costs involved as outlined on your FAQs Yes
No
To the best of my knowledge and understanding, I meet the minimum background requirements to be enrolled Yes
No
Uncertain ... (There is room for questions and clarification at the bottom of this form)
I will be able to complete my "classroom" lessons by email through your distance learning program with the assistance of a faculty mentor to be provided by the seminary at no extra charge Yes
No
I will be able to arrange for an agency in my community where I can meet my on-site direct-patient-care obligations (internship) Yes
No
I will be able to locate and arrange to work with a mentor in my community who can guide me and oversee my on-site internship Yes
No
I agree that I will be able to keep careful and accurate "field notes" about my activity during each day's internship service and submit these to my mentor for approval Yes
No
I understand and agree to the fact that Clinical Pastoral Education Training Institute (www.cpeti.org) is a non-denominational Not-For-Profit center of educational excellence at TLC Worldwide Yes
No
IMPORTANT FINAL QUESTION: I understand that this form is designed to help develop a practical communication between the seminary and me. I agree that this form is a required first step toward my possibly applying for enrollment into a CPEti.org program and that there can be no movement in that direction by CPEti until this important step is completed. Yes
No
I have the following question(s) or comment(s) that I would like to have someone at www.cpeti.org get back with me to discuss
    If you have been able to answer "yes" to most of the questions in the yes-no
    section of this form, you may be eligible to move on to the next step in the
    application process.  If you wish to move forward with your exploration, please
    feel free to fill out this APPLICATION / INFORMATION FORM