Clinical Pastoral Education s1

L E T T E R O F R E C O M M E N D A T I O N CLINICAL PASTORAL EDUCATION

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PART ONE – APPLICANT Please complete Part One before giving this form to the person from whom you are requesting a reference.

Applicant Name:

Program applying for (check one): CPE Unit Course-Based CPE Practicum Type of Program (check one): Summer Intensive Extended (Autumn to Spring) Program Location (check one): Calgary Edmonton Start Program in the year: 2018 2019 2020 NOTE: All Reference Letters are to be sent to the AC-SPE Clinical Pastoral Education Intake Supervisor (see contact information at the bottom of the page).

Name of Person Providing Reference: Relationship to Applicant:

PART TWO – PERSON PROVIDING REFERENCE

The applicant named above has asked you to provide a reference for admission to the Clinical Pastoral Education program indicated. A more detailed assessment is welcome, should you wish to provide it, but we request that you complete this form even if additional comments are attached. The applicant will not have access to your comments unless you provide her or him with a copy, and any information you disclose will be held in confidence within the AC-SPE Supervisory Team. Please share whatever you feel is important for us to know about the applicant. After completing the form, please forward it to the address below. [Please do not return the form to the applicant.]

Alberta Consortium for Supervised Pastoral Education CPE Intake Supervisor Rev. Dr. Philip Behman CASC/ACSS Supervisor-Educator, CPE Spiritual Care Services Alberta Children's Hospital 2888 Shaganappi Trail NW Calgary, AB T3B 6A8 Fax: (403) 955-2444 Phone: (403) 955-7868 [email protected]

1 How long, and in what capacity, have you known this applicant?

Please assess the applicant according to the following qualities, checking the one column in each row that best describes this individual. Has Has Needs Limited Unable to Demonstrates Demonstrates Potential Assessment Further Capacity Assess Superior Good To Qualities Training or To or Not Performance Performance Perform Development Perform Applicable Well Well Oral communication skills.

Written communication skills.

Leadership in the workplace.

Dependability.

Analytical/critical thinking.

Breadth of general knowledge and awareness of spirituality. Ease in interpersonal communications. Ability to work independently.

Able to Use Emotions in a Healthy Way

Creativity.

Pastoral/Spiritual Care/Ministry effectiveness.

Self Awareness

Openness to learn and grow

2 Please use the following space to comment on the above assessment of this applicant’s qualities and potential for success in the Clinical Pastoral Education program.

Overall assessment of this applicant (please check one): I recommend, without reservation, that this applicant be admitted to the program. I recommend, with some hesitation, that this applicant be admitted to the program. I do not recommend that this applicant be admitted to the program.

Signature: ______Date: Name: Phone: Position/Title: Address: E-Mail: ______

Thank you for providing this reference; we may be in contact with you should further detail or clarification be necessary.