Application for Residency and Supervisory Education
Deadlines for Residency:
December 31 - for those who have completed a unit of CPE;
March 15 - for those in a current unit, and others who missed December 31.
Deadline for Supervisor Education: August 15, 2013.
- 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.
- 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.
- 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,
- 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
- 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
- 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
- Include copies of your and your
supervisor's evaluations of previous clinical pastoral
- Include curriculum vitae, academic
transcripts, including undergraduate, seminary, and any other graduate
- Applicants for Level I/II Residency must
have an admission interview at this center.
- 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.
- 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.)
We need a signed copy of the online application.
Please print a copy before pressing the
"Submit" button. Procede to Secure Online Application.