Application for Residency and Supervisory Education

1. Complete the UVa Application for Clinical Pastoral Education form. You can download the UVa CPE application and Letter of Reference Form to print off and fill in by hand (Adobe Acrobat Reader required), or you can fill out the secure online application form. A link to the form is located on the bottom of this page. Please be sure to use the print-friendly version of the form and print a copy before submitting. Sign the form and attach a recent photo. Then send with the following answered questions and $50 non-refundable processing fee. Make checks payable to: UVAHS Chaplaincy Services and Pastoral Education.
2. Please answer the following. The integrity of the information provided is essential. In a separate statement give a reasonably full account of your life and personal development up to the present time. Include any information you believe is significant and in particular, cover the following points: early family life, religious development and significant turning points in your life, educational experiences (degree majors, etc.), current family life, and occupational history.
3. In separate statements, please answer the following questions and provide explanations, if needed.
   
   a) Have you ever been suspended or dismissed from another CPE program? If yes, please explain.
   b) Have you ever been convicted of any felony or misdemeanor, excluding non-moving traffice violations? If yes, explain all circumstances surrounding the conviction.
   c) Is there anything else we should know about you that has not been covered in these two questions? If so, please explain.
   
4. Hours of service and education may be significant at times. Due to this context, comment on your present state of health (physical and emotional). Your comment should reflect answers to two questions in particular. Do you currently suffer from any health or emotional problem that affects, or may affect, your ability to perform your duties as a resident or intern in the department? Do you take any medication or drugs, including alcohol or any form of drug, legal or illegal, which may affect your ability to perform your duties as a resident or intern in the department? Applicants for Residency Year should ask one reference to comment on physical and emotional health and ability to fulfill a residency.
5. Give a statement of your professional goals and your goals for ministry. Include how you expect to utilize clinical pastoral education. Include in this statement your impressions of clinical pastoral education and your reason for making application.
6. Provide an evaluation of your pastoral experience. (If you have not had pastoral experience describe an incident in which you were called on to help someone, the nature of the request, your understanding of the request, and how you attempted to help.)
7. Include copies of your and your supervisor's evaluations of previous clinical pastoral education.
8. Include curriculum vitae, academic transcripts, including undergraduate, seminary, and any other graduate education completed.
9. Applicants for Level I/II Residency must have an admission interview at this center.
10. Applicants for Supervisory Education: Download a Supervisory Packet, and then complete items 1,2,3,4,5,7,8 from above. Submit four papers of not more than 5 single-spaced pages on the following topics: vision of ministry paper, theology paper, and an understanding of CPE paper. Also submit a recent verbatim or case study and tentative learning goals.
11. For current UVa CPE Residents: If you choose to reapply for second year of residency, you will need to submit a brand new application. For item #2, please update your personal history to include reflections on this past year of CPE. Update item #5 with new learning goals, including how you will utilize a second year of CPE. Please be responsible for making your own copies of evaluations. You will not need to request college or seminary transcripts again. However, you should submit an official transcript of any new courses you completed.

(Residency application materials may be read by the director of Graduate Medical Education. Materials for successful residents are kept in the GME Office according to the Standards of General Medical Education Programs.)

**Online Applicants**
We need a signed copy of the online application. Please print a copy before pressing the "Submit" button. Procede to Secure Online Application.