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California Lutheran University
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PLTS CPE Notification & Scholarship Application
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Student Information
First Name
Last Name
Student ID
Email Address
Program
MDiv
MA
CATS
Other
If other, please name:
Site Information
Please send your CPE offer letter/email to contexted@plts.edu
CPE Site
City, State of Site
CPE Educator Name
Start Date
Start Date
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End Date
End Date
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Kind of CPE program?
intensive (10-12 weeks, full-time)
extended (18-25 weeks, or more, part-time)
What type of CPE program are you enrolling in?
fully in person
hybrid - online education & fully in-person clinical hours
hybrid - online education & in-person and online clinical hours
fully online - for education and clinical hours
Has your candidacy committee approved online CPE?
Has your candidacy committee approved online CPE?
Yes
No
Where / how will you complete your pastoral / spiritual care hours?
Costs during CPE:
I would like to be considered for a CPE scholarship
I would like to be considered for a CPE scholarship
Yes
No
Will you take leave from employment during CPE?
No
Yes - reduced pay
Yes - unpaid
Will you relocate for CPE?
No
Yes - will need to pay for housing
Yes - will not need to pay for housing
Does your site offer a stipend?
Does your site offer a stipend?
Yes
No
Stipend Amount:
CPE Site Fee
Travel to/from CPE site:
approx total for entire
term of CPE
Moving costs
Housing costs
What are your housing plans?
Address During CPE
(if known)
Address During CPE
(if known)
Country
Street
City
Region
Postal Code
By placing my name below
, as a digital signature, I confirm that all above information is correct to the best of my knowledge. I also agree to send my final self and supervisor evaluations to the PLTS Office of Contextual Education, to be kept on file.
These evaluations might be shared with select PLTS faculty for candidacy purposes.
No grade will be given for CPE until all evaluations are on file at PLTS.
Student Signature
Submit