New Returning CPE Student Enrollment

Returning CPE Student Enrollment

Welcome Back!

You can save your application at any time you wish and return back to it at a later time.

If you have any questions about the application and enrollment process, please contact administration@icpt.edu

(IMPORTANT: Please use your original first name, last name and email. You will then receive an email with a link to submit your returning student application.)

Campus

Prefix

First name

Middle Name

Last Name

Title

Contact Address 1

Contact Address 2

City

State/Province

Zip/Postcode

Country

Home Phone

Cell Phone

Social Security No

Birth Date

Enrollment Agreement

By proceeding with this agreement, I understand that I am enrolling in 1 unit(s) of Clinical Pastoral Education (CPE), and that each unit is 400 clock hours, which are broken down as follows: 300 clinical/applied clock hours and 100 didactic/lecture clock hours. I acknowledge that class schedules will be determined by unit cohorts and agreed upon before the start of the semester. I understand that I have the right to withdraw at any time. I also understand that there is no notification to withdraw.

Enroll In

Program

Program Start Date

For your program start date, please refer to our website: icpt.edu/schedules.html

Program End Date

What Type of Unit are You Applying For?

Name of Clinical Site:

Street Address of Clinical Site:

City:

State/Province/Territory

Zip Code/Postal Code

First Name of On-Site Clinical Supervisor:

Last Name of On-Site Clinical Supervisor:

Phone Number of On-Site Clinical Supervisor:

Only enter numbers i.e. 4072186481

Email Address of On-Site Clinical Supervisor:

Tuition Payment

Tuition must be paid, in full, prior to the start of the unit unless the student has a Third-Party Sponsor and with the approved Third-Party Sponsor paperwork on file (see Third Party Sponsorship section in handbook for more details). Failure to pay in full prior to the start of the unit and/or failure of Third-Party Sponsorship payment will result in disenrollment. Any past due balances from previous units must be paid in full to enroll into subsequent units

Standard Tuition and Fees

Application Fee (one-time, non-refundable)	$150.00
Tuition per Unit for Clinical Pastoral Education Units 1, 2, 3, or 4	$1335.00

Other Fees

Returned Check Fee	$50.00
Certificate of Completion Replacement Fee/Document Research Fee	$50.00
Payment/Refund Processing Fees*	varies

*Payment and refunding fees are determined by the student choice of payment method vendor (PayPal standard transaction fee is 2.90% + $0.30. This fee is not returned in the event of a refund.)

Payment Methods

Tuition is paid during the enrollment process online by credit/debit card or PayPal Credit only. Telephone payments will not be accepted. All refunds are processed through the student’s selected payment method, which may include processing fees.
PayPal transactions may incur processing fees, which are not returned by PayPal in the event of a refund. PayPal’s current standard fee rate for online transactions is 2.90% of the transaction amount plus a fixed fee ($0.30). Additional PayPal fees may apply such as international transaction fees. All applicable PayPal fees can be found at https://www.paypal.com/us/webapps/mpp/paypal-fees.

Third Party Sponsorship

If you are sponsored by a Third Party or Corporate Site, please fill-in all Third Party Sponsor information. Approved Third-Party Sponsor paperwork must be on file with all required signatures. If tuition is not paid by the end of the sixth week of training, the student will be billed for any outstanding tuition and fees. Failure to pay tuition and fees in a timely manner may result in suspension of training or administrative withdrawal. Students will not be permitted to enroll in future units until all tuition and fees have been paid.

Third Party Sponsor?

Corporate Name/ Sponsor Name

Phone Number

Address

Cancellation and Refund Policy

The Institute for Clinical Pastoral Training (ICPT) maintains a refund policy that clearly identifies the refund due if the student cancels, withdraws, or is terminated from the program or if ICPT cancels a unit. The following definitions and procedures are the key components of this policy.

Definitions

Applicant Rejection

Application for enrollment is rejected by ICPT following the submission of a Student Application.

Program Cancellation

CPT cancels a unit prior to or after the start date.

No Show

Student never attends class at the institution after enrolling and does not inform the institution. Students who do not attend or communicate with ICPT within the first week will be automatically disenrolled as a No Show.

Student Disenrollment

Student formally requests to disenroll from the unit/program. The date of the formal notice to ICPT faculty or staff is the effective date of the student disenrollment. Students may submit cancellation/withdrawal requests to the Director of Education and Administrative Director at withdraw@icpt.edu. Student disenrollment is categorized as:
Cancellation / No Start –Student accepted for Enrollment by ICPT requests disenrollment prior to the start of the unit and/or within the first week of the unit with no academic activity (see Last Day of Attendance definition for academic activity).
Withdrawal – Student requests disenrollment within the first week of the unit with academic activity and/or requests disenrollment within the second week of the unit or thereafter

Administrative Withdrawal / Termination

Institution may terminate a student’s enrollment in a unit for failure to meet academic, attendance, and/or conduct policies. No advanced notice is required for administrative withdrawals and may occur for the following reasons:

- failure to attend two (2) consecutive video group meetings; and/or
- failure to attend two (2) consecutive supervisory coaching sessions; and/or,
- failure to log-in to the ICPT Learning Center for two (2) consecutive weeks; and/or
- failure to attend and post on the discussion board(s) in their cohort within the ICPT Learning Center for two (2) consecutive weeks; and/or
- failure to submit two (2) consecutive required assignments; and/or
- failure to comply with ICPT’s policies and procedures.

Last Date of Attendance (LDA)

Due to the nature of ICPT’s Interactive Distance Learning environment, the last date of attendance is defined as the last date of student academic activity within the ICPT learning environment, including: accessing course content in the Learning Management System (LMS), submitting an assignment, and/or participating in a supervisory session, discussion forum, or cohort meeting.

Date of Determination (DOD)

The effective date of cancellation: the date of ICPT program cancellation, the date the student provides cancellation/withdrawal notice to the institution, or the date the institution terminates or disenrolls the student by applying the attendance, conduct, or satisfactory academic progress policy.

Refunds

Refund Amounts are determined based on the nature and date of cancellation, rejection, and/or last day of attendance. All Students rejected or disenrolled from a unit will receive a Tuition Refund Worksheet. Refunds, if applicable, will be processed within 45 days from the date of determination via the method of payment utilized by the student (e.g., debit/credit card, PayPal Credit, or check (if applicable) subject to payment method processing fees. ICPT is not responsible for lost checks.

Applicant Rejection

Student will be refunded 100% of tuition paid; ICPT will retain the application fee.

Program Cancellation

Students enrolled prior to cancellation will be refunded 100% of all tuition and fees paid.

No Show, Cancellation, or No Start

Student will be refunded 100% of tuition paid; ICPT will retain the application fee.

Withdrawal or Termination

Refund amounts for Withdrawal or Termination after the Start Date of a Unit will be based on the student’s LDA. When determining the number of weeks completed by the student, the institution considers a partial week the same as if a whole week were completed.
First Week of Unit – Student will be refunded 90% of the tuition paid. ICPT will also retain the Application fee.
Second through Sixth Week of Unit (12th week for part-time units) - ICPT will retain the Application fee; plus, a pro rata portion of the tuition for the training period completed.
After the Sixth Week of Unit (12th week for part-time units)– Student is not eligible for refund and is responsible for all tuition and fees.

I have read ICPT's Clinical Pastoral Education Tuition Refund Policy and hereby accept the terms of this policy.

Yes No Not Selected

HOW TO ADD YOUR SIGNATURE:

** If your device has a touch-screen, you can use your finger to sign this document. If you are using a non-touch screen, you can use your mouse to sign this document.
For any reason, if you are unable to sign electronic signature please type in your name. The typed in name will be considered as an electronic signature.

Student Signature

Student Signature Date

Date Signed

Full Name

For any reason, if you are unable to sign electronic signature please type in your name. The typed in name will be considered as an electronic signature.

Enrollment Acceptance

ICPT Director of Admissions

Acceptance Date

Date Accepted

Consent to Conduct Business Electronically

It is the student’s choice whether to do business electronically with ICPT through its website, Orbund - ICPT’s Student Information System (SIS), Microsoft Teams & Outlook – ICPT’s communication and video conferencing platforms, and Canvas - ICPT’s Learning Management System (LMS). If you choose to sign the enrollment agreement, you consent to ICPT communicating with you in electronic form and to entering into agreements and transactions using electronic records and signatures. Your consent expires upon completion of each unit and will require a new acceptance for transactions after that time. Agreements and transactions covered by this consent include, but are not limited to, the following:
• Registration: enrolling, dropping or withdrawing from courses; viewing student schedule, grades, and transcripts; ordering transcripts; applying for graduation; requesting and viewing degree audits; FERPA release requests; requesting enrollment verifications; etc.
• Financial Information: receiving disclosures and notices; viewing, accepting or declining financial assistance; reviewing communications; etc.
• Student Account: viewing tuition bills; cancellation and refund; viewing academic progress, notices, and change requests.
• Miscellaneous: updating contact and emergency contact information; receiving student consumer information; delegating access to another individual; etc.
In order to enroll at ICPT, the student must have access to an electronic device (e.g., computer, smartphone, tablet) with a supporting operating system that can connect to the Internet, an up-to-date Internet browser, an up-to-date PDF viewer, and sufficient electronic storage capacity on the electronic device to be able to save documents for later reference or be connected to a printer that is capable of printing from the browser. Federal law requires certain safeguards to ensure that you are capable of receiving and retaining communications and records electronically. By signing the enrollment agreement, you acknowledge that you have access to the necessary hardware and software as described above.
ICPT reserves the right to provide communications and engage in transactions and agreements with you in paper form at any time. By consenting, you agree that ICPT is not required to provide you with records in paper format. If you want a paper copy of any record that is sent to you electronically, you may print a copy from your electronic device or you may request paper copies from ICPT’s administration at no charge by emailing administrator@icpt.edu.

I certify that all the information in this Enrollment Agreement is factually true, complete, and honestly presented. I understand that I may be subject to disciplinary action, including admission revocation or program expulsion, should the information I have certified be false. I hereby give permission to ICPT to which I am applying to access my CPE evaluations and contact previous supervisory personnel about matters pertaining to this current Enrollment Agreement, and I consent for those contacted to provide the information sought. I am aware that my Enrollment Agreement will be read by professionals involved in the admission process, accreditors and other regulatory agencies in addition to a Clinical Pastoral Education supervisor. I verify that in sending this Enrollment Agreement electronically it constitutes as an understanding of my electronic signature.

By signing this agreement, I attest to reading and understanding the following ICPT Admissions and Enrollment Requirements:

- Applicants must be able to read, write, speak, and understand English.
- Applicants must be 18 or older.
- Applicants must have a bachelor's degree, or greater, from an accredited college or university and a minimum of two (2) years of ministerial experience or applicable professional experience.
- Applicants without a bachelor's degree must have a minimum five (5) years of ministry experience or applicable professional experience.
- Applicants must be willing to adhere to their own faith tradition and be willing to learn with those of faith traditions other than their own.
- Applicants must possess the ability to minister to persons in various emotional states.
- Applicants must be willing to learn from others and be able to communicate effectively to those who possess different values without proselytizing or evangelizing.
- Applicants must have his/her own transportation to get to and from unit sessions/clinical sites.
- Applicants must adhere to the policies and procedures at their clinical site and/or place of ministry including, but not limited to, working in a smoke-free environment.
- I have downloaded and read the Student Handbook at http://www.clinicalpastoraled.org/enroll.html or received a copy from ICPT administrators
- I have read the current ICPT Student Handbook
- I have read, understood, and received a copy of this completed and executed application in my student portal.

With my signature above, I acknowledge this agreement becomes a legal and binding contract once submitted and accepted by the institution.

Enter the above code

Required

The Institute for Clinical Pastoral Training | 360 Rob Roy Dr., Clermont, FL 34711 | Phone: (407) 218-6481