APPLICATION FOR PROGRAM APPROVAL for a Supervised Pastoral Education Centre
Centre Name: | Supervisor Name: / Page 1 of 9

Form 4.1 APPLICATION FOR PROGRAM APPROVAL

for a Supervised Pastoral Education Centre

Instructions:Submit SPE Program Approvals electronically to the chair of the CASC Accreditation Committee approximately three months prior to the start of the program. The most responsible supervisor/educator for the program writes the document with support from other supervisors. This document is fillable and blocks will expand. A few questions specifically ask for attachments to be embedded or attached with the application and a few questions present an option to embed or attach further information. Please contact the accreditation chair if you have questions.

Submit a program approval in the following circumstances:

  • Upon completion of a second provisional unit, or upon certification as a supervisor/educator
  • When a supervisor isestablishing a new SPE program
  • When a new supervisor is taking over the supervision of a currently approved program. In the latter case, the supervisor may use the previous program approval and note changes or updates.

PERSONAL INFORMATION
Name of Applicant (Supervisor)
Supervisory Status
Address
Telephone / home
office
Mobile
Email
CENTRE INFORMATION
Name of SPE Centre
CASC Region
Centre Address
Stream / CPE ☐ / PCE Unit based ☐
PCE Course based ☐ / Blended CPE/PCE ☐
Is this program application
for a Residential Program? / Yes ☐ No ☐
Start Date of Intended Program
End Date of Intended Program
OVERVIEW OF CENTRE
  1. Provide a brief description of the host site/centre for the SPE program.
Include: location, setting description, size of centre or facility, population(s) with whom students will be working,
programs at the site, and unique learning opportunities.
Word Count: / /500
  1. Has there previously been an SPE Program at this centre? Yes☐No ☐
If YES, please provide a brief history.
Word Count: / /300
STAFF
If supervising a provisional supervisor, include information for all supervisors.
  1. Briefly describe the professional and academic credentials of the supervisors/educators facilitating this SPE unit and include their areas of expertise as applicable to the SPE program. What is the role of each supervisor at the centre?

Word Count: / /300
  1. Identify to whom, at the centre, each supervisorof the SPE program is accountable.

Word Count: / /150
  1. Describe how the Centre supports the continuing education
of the SPE Supervisor(s).
Word Count: / /150
  1. If the Teaching Supervisor is supervising a provisional supervisor at a distance,
describe how supervision will take place.
Word Count: / /250
  1. Who are the other faculty, community members, or staff members, offering didactics for the program? If identified in your syllabus (#24) please simply refer to syllabus here.

Word Count: / /200
Reference attached document (optional):
☐
Answer question #8 and #9 only if the students’ clinical placements
are in locations separate from the organization or main centre hosting the SPE.
  1. Identify who will be the students’ on-site supervisor or preceptor. Describe how the on-site supervisor will help the student integrate theory and practice.

Word Count: / /200
  1. Describe/Attach the agreement between the SPE program centreand the individual satellite locations,including the roles and responsibilities for each. (Suggest - include the number of contracted student hours, role of on-site supervisor, student position expectations).

Word Count: / /250
Reference attached document:
☐
RESPONSIBLE RELATIONSHIPS
  1. Please identify the theological school or faculty with whom the SPE unit will be affiliated.
Attach a letter from the theological school affirming the relationship between it and the SPE program.
Word Count / /100
Reference attached document:
☐
  1. Provide written endorsement from the person to whom the supervisor reports (i.e. a member of the centres’senior management team) including an expression of willingness to support the SPE program.

Word Count / /100
Reference attached document:
☐
  1. The SPE program willhave a team that provides support, consultation and feedback regarding the program.
The team will be unique to the needs of the Centre, but is often inter-disciplinary and represents diversity.
Please include the names and role information of the SPE Advisory Committee members.
Word Count: / /250
Reference attached document (optional):
☐ i.e. SPE Advisory Committee Terms of Reference
FACILITY/CENTRE
  1. Check off all supportive structures that apply:

☐ / office space for students
☐ / group supervision rooms
☐ / space for confidential individual supervision
☐ / educational equipment (i.e. video/audio-taping/observation room)
☐ / access to administrative assistance support
☐ / access to photocopying/scanning/faxing services
☐ / student access to computers for charting or workload if required
☐ / access to library facilities
☐ / access to financial assistance for students
☐ / access to distance education technology (i.e., webinars, video conferencing)
Describe any further supportive structures that support the student’s learning:
Word Count: / /250
  1. Describe the variety of clinical placement opportunities the SPE students will have at your Centre (If not identified in question #1).

Word Count: / /250
POLICIES AND PROCEDURES
  1. Briefly describe the Admissions Policy/Procedure and attach the document sent
to interested students in the SPE program. (Include dates, registration process, costs, teaching supervisor, etc.). Note how diversity and respect for all persons is ensured.)
Word Count: / /250
Reference attached document:
☐
  1. Briefly describe the interview and selection process (include who participates in the interviews, i.e. colleagues or member of the SPE Advisory Committee).

Word Count: / /250
Reference attached documents (optional):
☐
  1. I acknowledge that I will provide a copy of the following documents to the SPE students
and will make reference to them during orientation.
☐ / CASC/ACSS Code of Ethics
☐ / CASC Grievance Policy
☐ / CASC Dismissal Policy
☐ / A confidentiality agreement (PHIPA)
  1. Describe the process at your Centre for addressing both formal student complaints
and student withdrawal from the SPE program.
Word Count: / /250
  1. I acknowledge I will securely store and dispose of student information including final evaluations.

☐ / Yes, I will securely store and dispose of all student information and agree with the statement below.
Both the Student’s Final Self-Assessment and Summary and the Supervisor’s Final Assessment and Summary are property of the student assessed and an educational tool. These documents will be kept on file (hard-copy and electronic), securely, for a period of five (5) years, after which it will be destroyed. Copies of these documents will not be released to anyone without written permission of the student assessed.
none
THE SPE PROGRAM
  1. I acknowledge that the program goals and objectives align with the CASC education standards as cited below.

☐ / Yes, these goals and objectives are woven into the SPE educational program.
  1. Goals of Basic CPE/PCE
  2. To become aware and demonstrate awareness of one's personhood in the practice of spiritual care and of the ways one's spiritual care practice affects other persons, including sensitivity to ecumenical, multi-faith and multicultural issues.
  3. To become aware and demonstrate awareness of how one's attitudes, values and assumptions affect one's spiritual care practice.
  4. To become aware and demonstrate awareness of one's spiritual care presence in interdisciplinary relationships.
  5. To develop the ability to utilize the experiential method of learning.
  6. To develop the ability to utilize the peer group for support, dialogue and feedback in a way that integrates personal characteristics with spiritual care functioning.
  7. To use individual and group supervision for personal and professional growth and for developing the capacity to evaluate one's spiritual care practice.
  8. To integrate the learnings of theology, spiritual/religious theories and the social and human sciences in understanding the human experience.

Goals of Advanced CPE/PCE
4.1.To become competent in the practice of spiritual care and/or pastoral counselling with persons and groups in various life situations and crisis circumstances and develop the skills to provide intensive/ extensive spiritual care and/or counselling.
4.2.To draw upon the experiential method of learning.
4.3.To engage the support, dialogue, and feedback of the peer group for the integration of personal characteristics with one’s functioning as a spiritual care and/or pastoral counselling professional.
4.4.To become competent in self-evaluation and in utilizing supervision and consultation to evaluate one's spiritual care and/or pastoral counselling practice.
4.5.To develop the ability to make optimum and integrated use of one's religious heritage, theological, spiritual, and ethical understandings, and knowledge of psychological and social sciences in the practice of spiritual care and/or pastoral counselling to persons and groups, including sensitivity to ecumenical, multifaith and multicultural issues.
4.6.To acquire self-knowledge to a degree that permits spiritual care and/or counselling to be offered within the strengths and limitations of one's own personhood.
4.7.To develop the ability to work as a spiritual care and/or pastoral counselling member of a multidisciplinary team.
4.8.To develop the capacity to utilize one's spiritual care and/or pastoral counselling perspectives and competencies in a variety of functions, such as spiritual care, counselling, worship leadership, teaching and administration.
Word Count: / none
  1. Provide a statement or attach a document outlining the total number of weeks and the number of hours each week for the students in the program. A sample is provided.

Example: Didactic/classroom hr
Orientation hours / 15
Didactic presentations/workshops / 50
Group supervision and IPR / 105
Individual supervision / 10
Mid-Unit Assessments / 6
Final Assessments / 14 / 200
Clinical hours / 200
TOTAL / 400
Word Count: / /250
Reference attached document (optional):
☐
  1. If using video/tele-conferencing (distance education), identify the technology format (e.g. WebEx, OTN), what will be offered (i.e. supervision, didactics) and how you will ensure sufficient support for the students or on-site supervisor. (See Video-Conferencing Standards and attach the agreement with the on-site clinical supervisor)

Word Count: / /250
Reference attached document (optional):
☐
  1. Describe the use of learning contracts or learning goals with students.

Word Count: / /250
Reference attached document (optional):
☐
  1. Provide a description of the didactic content or course syllabus. Include information about the method of program delivery(lectures, group learning, on-line, student lead seminars, self-learning, etc.).

Word Count: / /250
Reference attached document:
☐
  1. Describe how your program incorporates the ten CASC Spiritual Care and Counselling Competencies.

Word Count: / /250
Reference attached document (optional):
☐
  1. Describe the number and types of reports required of the students (if not already identified in #24).

Word Count: / /100
  1. Describe how students are evaluated throughout the program in addition to the final assessment.
Include information regarding opportunities to observe the students’ clinical activities and competencies.
Word Count: / /250
  1. Describe how the faculty/supervisors evaluate the program and how the student feedback
is acquired and processed to improve future SPE units.
Word Count: / /250
Reference attached document (optional):
☐
  1. Is there anything else you would like to tell us about your program
that has not already been included?
Word Count: / /250
  1. I am aware of the following (check off each that applies):

☐ / After receiving program approval, I will inform the Accreditation Committee of significant changes.
☐ / I will be preparing for a Site Accreditation Visit after several units or after three years.
☐ / The SPE Advisory Committee has a role in preparation for a site accreditation visit and they will form or appoint a study/review group 6-10 months prior to the visit.

Respectfully submitted,

Name of supervisor / Date
Name of Provisional (as needed) / Date

When completed please send to the chair of Accreditation:

Angela