2016 Clinical Pastoral Education Internships

Transcription

1 2016 Clinical Pastoral Education Internships Site Medical Center Beth Israel HUC-JIR/ St. Luke s- Roosevelt CPE Supervisor The Rev. David Fleenor Rabbi Nathan Goldberg Rabbi Jo Hirschmann Start Date End Date Weekly Class Time 2/1/16 5/13/16 Wednesday 2/1/16 5/13/16 Tuesday 2/1/16 5/13/16 Thursday Weekly Clinical Time Application Deadline Send Application to: 11/1/16 David.Fleenor 11/1/16 Nathan.Goldberg 11/1/16 Jo.Hirschmann Site Medical Center Beth Israel HUC-JIR/ St. Luke s- Roosevelt CPE Supervisor The Rev. David Fleenor Rabbi Nathan Goldberg Rabbi Jo Hirschmann Start Date End Date Weekly Class Time Weekly Clinical Time 5/31/16 8/5/16 Daily 30 hours 5/31/16 8/5/16 Daily 30 hours 5/31/16 8/5/16 Daily 30 hours Application Deadline Send Application to: 2/1/16 David.Fleenor 2/1/16 Nathan.Goldberg 2/1/16 Jo.Hirschmann 1

2 Site Medical Center Beth Israel HUC-JIR/ St. Luke s- Roosevelt CPE Supervisor The Rev. David Fleenor Rabbi Nathan Goldberg Rabbi Jo Hirschmann Start Date End Date Weekly Class Time 9/12/16 1/6/17 Wednesday 9/12/16 1/6/17 Tuesday 9/12/16 1/6/17 Thursday Weekly Clinical Time Application Deadline Send Application to: 5/1/16 David.Fleenor 5/1/16 Nathan.Goldberg 5/1/16 Jo.Hirschmann 2

3 Application for Clinical Pastoral Education TO WHICH PROGRAM ARE YOU APPLYING? (Please check the appropriate boxes) Fall Half-Time (15-20 weeks) Spring Half Time (15-20 weeks) Summer Full-Time (10-11 weeks) Medical Center Beth Israel St. Luke s 1 st Year Residency (12 months) Roosevelt 2 nd Year Residency (12 months) TUITION AND FEES Please note that there is an application fee that must be paid when you submit your application. Please make a check out to Medical Center and add CPE Application Fee in the notes section of your check. Mail it to the address above along with your application. Or you may pay by credit card by calling Ms. Norma O Neill at INTERNS: The total cost of the CPE unit is $950. Application fee (non-refundable) $50 Deposit (non-refundable; due upon acceptance to hold your spot): $100 Tuition: $800 RESIDENTS: The total cost to apply and hold your spot is $200. Residents receive an annual stipend of $30,000 plus benefits and do not pay tuition. Application fee (non-refundable) $100 Deposit (non-refundable; due upon acceptance to hold your spot): $100 Tuition: $0 APPLICATION Please input your information directly into the boxes provided below or answer the questions in a separate document and it along with this form to Norma.O Neill. If you prefer snail mail, please send the application to: Ms. Norma O Neill Registrar for Spiritual Care and Education c/o The Medical Center Box Gustave Levy Place New York, NY Page

4 Application for Clinical Pastoral Education Name: U.S. Citizen: YES or NO Fax: Permanent Address: Denomination/Faith Group Affiliation: Local Church & Ministry Position: Ordained/Licensed/Appointed: Date: College: Degree: Date: Seminary/Rabbinic School: Degree: Date: Graduate School: Degree: Date: Prior CPE: Please List Dates, Supervisor, and Center 2 Page

5 Application for Clinical Pastoral Education Choose three reference persons. Send each person a reference form. List their information below so we may know from whom to expect a reference form. Academic Reference Name: Title: Denominational Reference Name: Title: Personal Reference Name: Title: 3 Page

6 APPLICATION QUESTIONS Application for Clinical Pastoral Education 1. A reasonably full account of your life. Include, for example, significant and important persons and events, especially as they have impacted, or continue to impact, your personal growth and development. Describe your family of origin, current family relationships, and important and supportive social relationships. Please pay attention to times of woundedness and healing as you articulate your biography. This section should be two to five doubled-space pages in length. 2. A description of your spiritual growth and development. Include, for example, the faith heritage into which you were born and describe and explain any subsequent, personal conversions, your call to ministry, religious experiences, and significant persons and events that have impacted, or continue to impact, your spiritual growth and development. 3. A description of your work (vocational) history. Include a chronological list of jobs/positions/dates of employment and a brief statement about your current employment and work relationships. This section should be two to five doubled-space pages in length. 4. An account of a helping incident in which you were the person who provided the help. Include the nature and extent of the request, your assessment of the issue(s), problem(s), situation(s). Describe how you came to be involved and what you did. Give a brief, evaluative commentary on what you did and how you believe you were able to help. If you have had prior and recent CPE, please attach a copy of a recent verbatim as your 'helping incident' and add to the verbatim your own notes on how and what you learned from 4 Page

7 Application for Clinical Pastoral Education sharing this verbatim with your supervisor and/or peers. If you have had CPE, but it was more than two years ago, include a recent account of a helping incident, written up in a verbatim format. If possible, include feedback from current pastoral colleagues and/or administrative supervisor. 5. Your impressions of Clinical Pastoral Education. Indicate, for example, what you believe or imagine CPE to be. Indicate if CPE is being required of you. Indicate any learning goals or issues of which you are aware and would like to address in CPE. Finally, indicate how CPE may be able to help you meet needs generated by your ministry or call to ministry. If you have had prior CPE, please indicate the most significant learning experience you had during CPE. State how you have continued to use the clinical method since your previous experience. Indicate strengths and weaknesses that you have as they relate to your ministry and your identity as a professional person. Indicate any personal and/or professional learning goals and issues that you have at this time and how you believe that CPE will help you to attain or address these learning goals and issues. 6. An applicant with prior CPE should attach all previous self and supervisory evaluations. ADMISSION S INTERVIEW After reviewing your application a determination will be made as to whether you will be invited for an interview or not. If the decision to interview you is made then someone from Mount Sinai will contact you to arrange the interview. 5 Page

8 INTERNATIONAL APPLICANTS Application for Clinical Pastoral Education If you are an international applicant, you will have to obtain appropriate documentation from U.S. Immigration, which usually implies a visa and a US Social Security Number. Therefore, international applicants should have such documentation approved at least six (6) months prior to the start of the program to which they are applying. If offered employment, can you submit verification of your legal right to work in the U.S.? YES or NO CRIMINAL BACKGROUND Have you ever been convicted or pled nolo to a misdemeanor, a felony, or other crime? YES or NO CERTIFYING STATEMENT I certify that all information in this application is factually true, complete, and honestly presented. I understand that I may be subject to disciplinary action, including admission revocation or program expulsion, should the information I ve certified be false. I hereby give permission to the ACPE center to which I am applying to access my CPE evaluations and contact previous supervisory personnel about matters pertaining to this current application, and I consent for those contacted to provide the information sought. I verify that if sending in this application electronically it constitutes my electronic signature. Signature: Date: 6 Page

9 Clinical Pastoral Education Reference Form CPE Applicant Name: Title: TO WHICH PROGRAM ARE YOU APPLYING? (Please check the appropriate boxes) Fall Half-Time (15-20 weeks) Medical Center Spring Half Time (15-20 weeks) Beth Israel Summer Full-Time (10-11 weeks) St. Luke s 1 st Year Residency (12 months) Roosevelt 2 nd Year Residency (12 months) Reference Name: Title: This information will be kept strictly confidential. Please do not return this reference to the candidate. Send it directly to: Ms. Norma O Neill Registrar for Spiritual Care and Education c/o The Medical Center Box 1036, 1 Gustave Levy Place New York, NY Norma.O Neill 1 P age

10 Clinical Pastoral Education Reference Form 1. How long have you known the candidate, and in what capacity? 2. How do you evaluate the candidate: a. In his/her potential for pastoral effectiveness? b. In his/her personal commitment to learning? c. In his/her maturity of faith and depth of spiritual development? 3. If you were hospitalized, how would you feel about him/her visiting you? 4. What do you think of his/her plan to do Clinical Pastoral Education? (Comment on the candidate s motivation, attitude, and readiness for CPE, etc.) 2 P age

11 Clinical Pastoral Education Reference Form 5. Please evaluate the candidate on the following scale. Intellectual Ability General Knowledge Job Perseverance Emotional Maturity Creativity Pastoral Effectiveness Interpersonal Communication Excellent Very Good Good Weak Very Weak 6. Please elaborate on any of the above. 7. Additional remarks, comments or concerns. 3 P age