Ken Waddell, Hamilton Medical Center chaplain Please complete all the fields below. Please contact Ken Waddell by phone or email with any questions 706.217.2015 • firstname.lastname@example.org Candidate’s Full Name: First Middle Last Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone (home):Phone (cell):Email Denomination/Faith Group:Jurisdiction/District/Diocese/Conference/Assoc:Ordained/Licensed/Appointed:College: Degree/Date:Seminary: Degree/Date:Grad School: Degree/Date:Prior CPE Date(s):Center:Supervisor:Autobiographical Reflection: * RequiredProvide a reflective autobiographical account of your life giving attention to pivotal life events and relationships that have shaped who you are as person. Please be specific and personal.Helping Incident:Describe a situation where you provided help to someone(s) facing a difficult life situation. Please supply a reflective critique of your intervention. Applicants who have been in CPE training will address this question by providing a Clinical Case.CPE/CPT Training:What’s your understanding of Clinical Pastoral Education/Training and what do you hope to gain for your personal/professional development?Curriculum Vitae:Please provide a brief Curriculum Vitae that documents your education, training and work experiences.File Upload:Please upload any pertinent documents. File Upload:Please upload any pertinent documents. File Upload:Please upload any pertinent documents.