Certification Commission Policy and Procedure Manual
Certification Commission Policy and Procedure Manual Certification Commission Policy and Procedure Manual
APPENDIX 3-C cont’d CERTIFICATION COMMITTEE SAMPLE 3 REPORT OF COMMITTEE ACTION EXTENSION OF CANDIDATE OR ASSOCIATE SUPERVISOR STATUS APPLICANT: ADDRESS: DATE: REGION: TRAINING CENTER: SUPERVISOR: PRESENTER: APPLICANT’S REQUEST: Extension: ___ Candidate status ___ Associate Supervisor status COMMITTEE ACTION: __________ Granted ___________ Denied ______________________________________________________________________________ Summary of Interview Process: Evaluate Applicant’s Rationale for Requesting an Extension: 3 Sample form adapted from a form developed by the ACPE Eastern Region 18
APPENDIX 3-C cont’d APPLICANT: Page 2 Evaluate the Applicant’s Response to Recommendations or Suggestions (or notations in the Case of Associate Supervisor) Given by Previous Certification Committees: Summarize the Applicant’s Supervisory and Supervisory Related Activities since the last Committee Appearance: Suggestions: NOTE: NOTATIONS MAY BE REMOVED ONLY BY THE CERTIFICATION COMMISSION COMMITTEE MEMBERS: (Please Print) _____________________________________ Presenter _____________________________________ Committee chair _____________________________________ _____________________________________ _____________________________________ ______________________________________ _____________________________________ Regional Accreditation Committee Chair 19
- Page 1: Certification Commission Policy and
- Page 4 and 5: CERTIFICATION COMMISSION POLICY AND
- Page 6 and 7: completing the Regional Certificati
- Page 8 and 9: Appendices APPENDIX 1 ACPE CERTIFIC
- Page 10 and 11: APPENDIX 2-A ACPE CERTIFICATION COM
- Page 12 and 13: APPENDIX 3-A CONSULTATION ON READIN
- Page 14 and 15: APPENDIX 3-A cont’d CONSULTEE: Pa
- Page 16 and 17: APPENDIX 3-B cont’d REGIONAL CERT
- Page 18 and 19: APPENDIX 3 B cont’d APPLICANT: Pa
- Page 22 and 23: APPENDIX 3-D The report of this mee
- Page 24 and 25: APPENDIX 3 D cont’d APPLICANT: Pa
- Page 26 and 27: APPENDIX 3 E REQUEST FOR ACPE SUPER
- Page 28 and 29: APPENDIX 3-E cont’d APPLICANT: Pa
- Page 30 and 31: APPENDIX 3-F APPEARANCE FOR REVIEW
- Page 32 and 33: APPENDIX 3 F cont’d INTERVIEWEE:
- Page 34 and 35: APPENDIX 3 G CONSULTATION TO MAINTA
- Page 36 and 37: APPENDIX 3 I COMMITTEE CONSULTATION
- Page 38 and 39: APPENDIX 5 ACPE ECCLESIASTICAL ENDO
- Page 40 and 41: ASSOCIATION FOR CLINICAL PASTORAL E
- Page 42 and 43: Declaration Procedures for Candidat
- Page 44 and 45: 6. How are persons prepared and tra
- Page 46 and 47: ________ 5. Is this group listed in
- Page 48 and 49: (Practical application: Is the theo
- Page 50 and 51: Appendix 11 Instructions from the C
- Page 52 and 53: e, and should not become, a continu
APPENDIX 3-C cont’d<br />
CERTIFICATION COMMITTEE<br />
SAMPLE 3<br />
REPORT OF COMMITTEE ACTION<br />
EXTENSION OF CANDIDATE OR ASSOCIATE SUPERVISOR STATUS<br />
APPLICANT:<br />
ADDRESS:<br />
DATE:<br />
REGION:<br />
TRAINING CENTER:<br />
SUPERVISOR:<br />
PRESENTER:<br />
APPLICANT’S REQUEST: Extension: ___ C<strong>and</strong>idate status<br />
___ Associate Supervisor status<br />
COMMITTEE ACTION: __________ Granted<br />
___________ Denied<br />
______________________________________________________________________________<br />
Summary of Interview Process:<br />
Evaluate Applicant’s Rationale for Requesting an Extension:<br />
3 Sample form adapted from a form developed by the ACPE Eastern Region<br />
18
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