AUSTIN HEALTH CPE CENTRE APPLICATION FORM Please complete form before printing 2016 (Applications Part time Unit Semester 2 19/7/16 8/12/16 Close 27/5/16) – (Applications Full time Unit Summer 14/11/16 27/1/17 16/9/16) Close – 2017 (Applications Part time Unit Semester 1 14/2/17 22/6/17 Close 16/9/16) – (Applications Part time Unit Semester 2 11/7/17 16/11/17 Close 13/5/17) – Full time Unit Summer 20/11/17 31/1/18 (Applications 8/9/17) Close – Have you applied to other CPE Programs? YES NO If YES, please list order of preference 1. 2. 3. NAME: DATE OF BIRTH: / / ADDRESS: POSTCODE: TELEPHONE: (H) (B) (Mob) EMAIL: DENOMINATIONAL/FAITH AFFILIATION: EDUCATION (please state institution and level of qualification) Secondary: Tertiary: Theological: Post Graduate study: PREVIOUS CPE UNITS CPE Centre: Year: Supervisor: CPE Centre: Year: Supervisor: CPE Centre: Year: Supervisor: Present Vocation: Other significant professional experiences:
AUSTIN HEALTH CPE CENTRE APPLICATION FORM Please complete form before printing 2016 Part time Unit Semester 2 19/7/16 – 8/12/16 (Applications Close 27/5/16) Full time Unit Summer 14/11/16 – 27/1/17 (Applications Close 16/9/16) 2017 Part time Unit Semester 1 14/2/17 – 22/6/17 (Applications Close 16/9/16) Part time Unit Semester 2 11/7/17 – 16/11/17 (Applications Close 13/5/17) Full time Unit Summer 20/11/17 – 31/1/18 (Applications Close 8/9/17) Have you applied to other CPE Programs? YES NO If YES, please list order of preference 1. 2. 3. NAME: DATE OF BIRTH: / / ADDRESS: POSTCODE: TELEPHONE: (H) (B) (Mob) EMAIL: DENOMINATIONAL/FAITH AFFILIATION: EDUCATION (please state institution and level of qualification) Secondary: Tertiary: Theological: Post Graduate study: PREVIOUS CPE UNITS CPE Centre: Year: Supervisor: CPE Centre: Year: Supervisor: CPE Centre: Year: Supervisor: Present Vocation: Other significant professional experiences:
2016-17%20CPE%20Application%20Form.docx