Association for Clinical Pastoral Education - Registration

ACPE Student Unit Registration Form

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Center:

Supervisor:

Unit End Date:

Enter student information here:

First Name	Initial	Last Name	Level of CPE Completed	Type of Unit Completed	Category of Student	Gender

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

			Faith Group:

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Date: 2/9/2010		1:29:01 AM
The Association for Clinical Pastoral Education, Inc		1549 Clairmont Road, Suite 103 Decatur, GA 30033-4611