Certification forms

The certifications forms are now available online. A list of the forms, and the corresponding certifications are shown below. The current forms take the place of the former facesheets, and recommendation forms that were submitted by the Chapter, in the past.

The following forms are in Microsoft Word. Please follow the instructions on the form to complete and submit them. Detailed instructions for the certification process are found in the CPSP Certification Manual. If you need Word, you can get it for free HERE.

Certification Form
(Click on the name of the form to download it)
Consultation Report for Clinicians Board Certified Clinical Chaplain;
Board Certified Associate Clinical Chaplain;
Board Certified Pastoral Counselor;
Board Certified Associate Pastoral Counselor
Consultation Report for Diplomate Psychotherapists Diplomate Psychotherapist
Consultation Report for Diplomate Supervisor Diplomate Supervisor in Clinical Pastoral Education
Training Supervisor's Report of Recommendation
for CPSP Diplomate Supervisor Candidate
Diplomate Supervisor in Clinical Pastoral Education
Consultation Report for Pastoral Psychotherapist Board Certified Pastoral Psychotherapist
Consultation Report for SIT and TS Program Supervisor-in-Training or Training Supervisor
Consultation Report for Hospice and Palliative Care* Clinical Fellow in Hospice and Palliative Care;
Clinical Associate in Hospice and Palliative Care
Consultation Report for Clinically Trained Minister* Clinically Trained Minister
Grand-parenting into CPSP Credentials All Clinician and Diplomate certifications;
applies to members currently certified
by an organization
*Contact Krista Argiropolis, Administrative Coordinator, for forms.