Alberta Consortium for Supervised Pastoral Education (AC-SPE)

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

NOTE: Forms such as this one can sometimes be problematic for users. The form is designed so the user can move from field to field by means of the “tab” or “down arrow” key, with mouse assist as may be helpful. If you would prefer to navigate this document without being limited to use of these keys, click “Developer” on the menu and unlock/click on the “Protect Form” icon (often looks like a padlock).

PART ONE – COMPLETED BY 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 directly to the Alberta Consortium for Supervised Pastoral Education (AC-SPE) CPE Intake Supervisorin either southern or northern Alberta (seen below):

Name of Person Providing Reference:

Relationship to Applicant:

PART TWO – COMPLETED BY PERSON PROVIDING REFERENCE

The applicant named above has asked you to provide a reference for admission to the Clinical Pastoral Education (CPE) 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 appropriate address below. [Please do not return the form to the applicant.]

Alberta Consortium for Supervised Pastoral Education CPE Intake Supervisors

CALGARY & SOUTHERN ALBERTA
Rev. Dr. Philip Behman
Certified Supervisor-Educator
Intake CPE Supervisor, Calgary & southern Alberta
c/o Spiritual Care Services
Alberta Children's Hospital
2888 Shaganappi Trail NW
Calgary, AB T3B 6A8
Phone: (403) 955-7868
/ EDMONTON & NORTHERN ALBERTA
Dr. Darlene Pranke
Provisional Supervisor-Educator
Intake CPE Supervisor, Edmonton & northern Alberta
c/o St. Stephen’s College
University of Alberta Campus
8810 – 112 Street
Edmonton, AB T6G 2J6
Phone: (587) 785-1536

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.

Assessment Qualities / Demonstrates
Superior
Performance / Demonstrates
Good
Performance / Has Potential
To Perform
Well / Needs Further Training or Development / Has Limited Capacity
To Perform
Well / Unable to Assess
or Not Applicable
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

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 (CPE) 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.

April 27, 2018