Clinical Pastoral Education Reference Form - Confidential

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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: CPE4401 Wornall Rd. 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

Ext:

Reference email address

Address

City/Town

State/Province

ZIP/Postal Code

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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