1. Thomas Jefferson University Hospitals Pastoral Care - Alumni Feedback Questionnaire (Page 1 of 4)

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This survey assists in the re-accreditation process for the Department’s Clinical Pastoral Education chaplaincy program. If you are a graduate of a CPE program that is/was connected to Thomas Jefferson University Hospital’s Department of Pastoral Care and Education, please complete this on-line questionnaire to provide feedback to the CPE Advisory Committee.

There are 4 short pages to this survey. Required questions are noted by a red *. At the end of each page click the next button. To submit this form, click on the done button at the end of the survey.

Thank you for participating in this brief survey. We look forward to using this feedback to improve services and education.

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* 1. Name (optional)

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* 2. Address (optional)

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* 3. E-mail (optional)

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* 4. Phone Number (optional)

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* 5. Today's Date

Date

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* 10. Your present ministry role:

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* 11. Your current job / position is:

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* 12. List certifications received since participating in CPE:

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* 13. List ordination or licensures obtained since participating in CPE:

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* 14. List degrees completed (and the degree-granting institutions) since participating in CPE:

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* 15. If you applied CPE credits toward a degree, give the name of the degree and the school / seminary:

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