ROYAL SOCIETY OF CHEMISTRY Mastership in Chemical Analysis (MChemA) Application for entry to Part C This examination is open only to Members (MRSC) or Fellows (FRSC) of the Royal Society of Chemistry. 1 Personal Details Name _____________________________________________ RSC membership number ___________________________________________ Category of membership ____________________________________________ 2 Address and Employment Address for correspondence: Address _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Telephone Email ____________________________________________ _____________________________________________ Your job title, the name and address of your current or most recent employer: Job title _____________________________________________ Employer name & address ___________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Postcode _____________________________________________ Telephone _____________________________________________ Email _____________________________________________ MChemA application form Part C 2015 3 Education and Training Please provide dates for the following: passed Part A _____________________ or exempted Part A _______________________ passed Part B _____________________ Please provide details of any further qualifications and experience gained since registration or since passing Part B: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 4 Part C Examination I wish to apply for entry to the Part C Examination to be held in __________ (year) 5 Signatures Signature of Candidate ____________________________________________________________ Date _______________________________ Internal Counsellor _______________________________________________________________ Signature ____________________________________________ Date _________________ External Counsellor _____________________________________________________________ Signature ____________________________________________ Date _________________ Please return by the closing date to: Dr Alex Kersting Registration Officer Royal Society of Chemistry Thomas Graham House Science Park Milton Road Cambridge CB4 0WF Email: mchema@rsc.org Website: www.rsc.org/mchema and include the fee for Part C. You can pay by cheque or credit card. Cheques should be made payable to ‘Royal Society of Chemistry’. MChemA application form Part C 2015 MChemA Part C Check List for your Portfolio of Evidence When you submit your portfolio, please make sure it contains the following, and include this sheet with your portfolio: 4 copies of the portfolio, hard copy or on CD Your signature and your Internal Counsellor’s signature attesting that the files are a true and accurate representation of your experience and are your own work (hard copy with original signatures) Evidence of practical skills that must include: - classical wet chemistry - speciation of meat and/or fish species - instrumental techniques including chromatography and absorption/emission spectroscopy - handling food and feed complaint samples 40 Reports covering food, agriculture and drinking water, including microbiology and complaints 40 Reports for product labels including original/copies of the labels and commentary A list, with brief commentary, of Statutes where the Public Analyst is mentioned as an authorised analyst Please sign to confirm: - Your record of practical ability is true and accurate in terms of methods, dates and depth of knowledge and experience; You and your Counsellor consider that you are competent in the handling and investigation of food complaint samples (which may include feed complaint samples); You have produced the certificates presented; You have interpreted the labels presented. Candidate ........................................................................... date .............................. Internal Counsellor ............................................................. date................................ MChemA application form Part C 2015