Clinical Pastoral Education Reference Form - Confidential

Current Personal information
Evaluate the candidate
Scale based evaluation
Complete

Indicates required field

Recommendation Form

Applicant is applying for admission into the Saint Luke's Clinical Pastoral Education. The program goal is to select and graduate quality laity, theological, spiritual students, and clergy to serve alongside an interdisciplinary team of professionals who care for patients and families in crisis. Please provide an honest and accurate evaluation of the applicant's abilities, as this is an essential factor in the selection process.

Please submit electronically, print and email ([email protected]), or print and mail to:
Saint Luke's Hospital of Kansas City Spiritual Wellness Department, attn: CPE
4401 Wornall Road
Kansas City, MO 64111

For more information about our Clinical Pastoral Education program, visit our website at saintlukeskc.org/cpe

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.

Applicant name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Reference name

Reference phone number

Reference email address

Address

City/Town

State/Province

ZIP/Postal Code

Country

Should this recommendation remain confidential?

Yes

Reference Position

Applying for

Extended Unit (Part time, Sept. - March)

Residency (Full time, yearlong- August to September)

Summer Unit (Full time, May to August)

Certified Educator CPE (Full time, three to five years)

How long have you known the applicant, and in what capacity