2.15 Pre-Certification Mentor’s Checklist and Report©

Personal Information: (please type or print)
Candidate’s Legal Name:
CASC Region:
Please indicate completion of steps in the Pre-Certification Mentor process.
I have ensured that the candidate not only knows but also understands the requirements for certification as a Spiritual Care Practitioner/Psycho-Spiritual Therapist
Together with the candidate, I have established a schedule of consultative sessions which allowed adequate time for the candidate to write the required documents. This schedule included time for the candidate to reflect on and incorporate feedback I offered in this writing process.
I have provided the candidate with:
Comments regarding the content and quality of the documents
Guided reading designed to enhance the candidate's understanding and practice of their specialty
Assistance in understanding the systemic as well as the personal dimensions of their practice specialty, including the political and economic realities of the practice setting, a sound understanding of administration, advocacy, interactions with staff and colleagues, and structural accountability
I have spent one of the consultative sessions in the candidate's practice setting in order to understand more clearly the candidate's Spiritual Care or Pyscho-Spiritual Therapy setting.(Preference, but not required.)
I have reviewed the completed documentation prior to its submission.

Report: (Please write and attach to this document a report of 250-350 words that incorporates the following points.)

1. Describe the consultative process – e.g. number and length of the sessions, overall length of the process, format of the process (group or individual);

2. Assess the candidate's strengths and weaknesses relevant to their practice specialty with particular focus on professional identity, authority and integration;

3.Comment on your assessment of the candidate’s documents;

4. Comment on your observations regarding how the candidate has addressed recommendations from previousAdmitting and Certification reviews;

  1. Provide a recommendation regarding the candidate's readiness to be certified as a Spiritual Care Practitioner/Psycho-Spiritual Therapist.

Please discuss this Checklist and the Report document with the candidate prior to her/his application for certification.

Both Pre-Certification Mentor and Candidate are asked to sign this document, and the original is to go to the Candidate.

Pre-Certification Mentor’s Name:
Pre-Certification Mentor’s Signature: / Date:
Candidate’s Name:
Candidate’s Signature: / Date:

Revised October2017 Posted December2017, 2.15 Page 1 of 1