Click here to download a copy of Certification Appendix P-3E
CONSULTATION FOR ACPE SUPERVISOR CERTIFICATION
The report of this meeting includes:
1. Evaluation of the applicant’s written materials.
2. An Appendix 8 (Certification Manual) signed by the Program Manager or designee attesting to meeting formal requirements.
3. Summary of the interview (describing the interaction of the applicant with the subcommittee).
4.Evaluation whether the applicant has:
4.1. independently conducted at least two units of CPE (neither co-supervised) since becoming an Associate Supervisor.
4.2. addressed satisfactorily recommendations for further professional development given at the granting of Associate Supervisor status.
5. Names of subcommittee members.
6. Commission actions – See ACPE 2016 Certification Manual, ACPE Supervisor Certification
CERTIFICATION COMMISSION REPORT OF COMMISSION ACTION
DATE:
ASSOCIATE SUPERVISOR:
ADDRESS:
REGION:
PRESENTER:
ASSOCIATE’S REQUEST: ACPE Supervisor Certification
(1) BRIEFLY EVALUATE THE ASSOCIATE’S WRITTEN MATERIALS:
(2) SUMMARIZE THE INTERVIEW: (Describe the interaction of the Associate with the subcommittee.)
(3) EVALUATE THE ASSOCIATE IN THE FOLLOWING AREAS: (See current edition of ACPE STANDARDS)
3.1.Has the Associate maintained faith group endorsement? ____ Yes ____ No
3.2.Has the Associate independently conducted at least two units of CPE (neither co-supervised) since becoming an Associate Supervisor? _______Yes _______ No
(4) The subcommittee appearance is a consultation. The Associate Supervisor is an ACPE Supervisor at the conclusion of the appearance.
(5) The subcommittee determines that ACPE Supervisor-level competencies are clearly being unmet and/or the students are being harmed; the subcommittee requests a Review of Supervisory Competence (See Certification Manual, Review of Supervisory Competence). If such action is being considered, the committee must confer with the Certification Commission Chair prior to making a decision. The Review of Supervisory Competency must occur within 120 days of this review.
5.1.Reasons for this action:
(6) Recommendations for further professional development
SUBCOMMITTEE MEMBERS:
1.
2.
3.
4.
5.
____________________
Name:
Chair, Certification Commission