Chartered Institute of Ecology and Environmental
Management
Application for Upgrade from Student Membership to
Qualifying Membership
Please read the Membership Regulations, Code
of Professional Conduct and Competency
Framework found on the CIEEM website before
completing this form.
Please ensure that:
1. all declarations have been signed;
2. copies of appropriate certificates/course
content are enclosed with your
application; and
3. payment has been authorised.
Failure to complete this form fully and accurately
will delay admission.
OFFICE USE
Date received:
Payment:
Acknowledged:
Sponsor:
Missing details:
Notified of outcome:
Please type in the boxes provided, or write in block capitals.
PERSONAL DETAILS
Surname:
Forename(s):
Employer:
Position:
Home
Address:
Work
Address:
Postcode:
Postcode:
Home Email:
Work Email:
Home Tel:
Work Tel:
Which is your preferred contact address? (please tick) Home
Title:
Work
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DETAILS OF HIGHER EDUCATION
1. This section must be completed fully; do not cross refer to a CV. A CV may be appended in addition.
2. Photocopies of all relevant qualifications, including degree certificates, must be appended to the
application.
3. A list of relevant degree courses transcripts or a syllabus summary listing main subjects studied
and/or details of modules taken within the degree must be included.
Degree Course Title
Dates
(from – to)
Institution/Awarding Body
CIEEM
Accredited
Degree (Y/N)
Qualification and
Classification
RESEARCH AND PUBLICATIONS RECORD
Please continue on a separate sheet if necessary, or incorporate with your CV.
MEMBERSHIP OF PROFESSIONAL BODIES AND LEARNED SOCIETIES
Please list all Professional Bodies and Learned Societies of which you are a member.
Professional body
Membership
category
(if relevant)
Date accepted into this
category
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DETAILS OF CURRENT PROFESSIONAL ACTIVITY
Current Employment Status
(e.g. Self-employed, employed, volunteer)
Position
Full/Part time?
Employer
Commencement
Date
Description of current professional role(s)
1. Please indicate grade or seniority level held.
2. Describe the main purpose or scope of the role.
3. Give details of some relevant tasks or projects undertaken.
PREVIOUS RELEVANT EXPERIENCE
Summary of all previous relevant projects/appointments held in the past 10 years (including periods of
voluntary work, work undertaken whilst self-employed and previous posts with a current or previous
employer if relevant). If you don’t have any previous relevant experience please leave this section blank.
If you wish to attach a CV in support of your application please append.
1. Begin with the most recent.
2. Dates (month/year) must be given.
3. Part time (PT) work must be detailed in full (i.e. number of days per week and/or month).
Start
date
End
date
Employer,
Organisation Role
or Client
Permanent
FT/PT or
Paid/
Actual
contract
Unpaid time in
(see 3
role
above)
Relevant duties and/or
experience (including
projects, responsibilities)
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CONTINUING PROFESSIONAL DEVELOPMENT (CPD)
Please describe any relevant training or Continuing Professional Development undertaken, e.g. courses
organised by CIEEM, external training providers or by your employer.
Date of
activity
No of
hours
Title & Description of
CPD activity
Provider
Structured
or
unstructured
(S or U/S)
Knowledge area or skill
developed and how it has
been applied to your
professional practice (max
100 words)
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SPONSOR’S DECLARATION
Sponsors cannot be related to applicants. You are asked to certify that:
1. you have read the Membership Regulations and Code of Professional Conduct;
2. you consider the applicant to be a person of integrity and that he/she is suitable for admission as a
Qualifying member; and
3. that the information contained herein is accurate to the best of your knowledge.
Name:
Position:
Capacity in which you know the
applicant: (e.g. colleague, manager)
Are you a CIEEM member?
Yes
No
Qualifications/ professional
memberships: (e.g. BSc, MSc, CEnv,
CEcol, MCIEEM)
Address:
Postcode:
Email:
Tel:
I confirm points 1-3 above and consider that to the best of my knowledge the applicant fulfils the
Chartered Institute’s conditions for Qualifying membership.
Signed:
Date:
OFFICE USE
Sponsor approved:
Comments requested:
Comments received:
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DECLARATION BY APPLICANT
By entering my name in the box below, I certify the above statements to be true and correct, to the best of
my knowledge, and that this information can be used for the purpose of processing my application for
Qualifying Membership of the Chartered Institute of Ecology and Environmental Management subject to
approval by the Governing Body of the Chartered Institute of Ecology and Environmental Management.
I agree that details pertinent to my application and membership history will be held and used by the
Chartered Institute of Ecology and Environmental Management, under the terms of the Data Protection Act
1998, for the purposes of establishing and maintaining membership of, or support for, the Chartered
Institute or providing and administering activities for members.
I confirm that I have read and agree to be bound by the terms and conditions of membership stated in the
Membership Regulations or any subsequent amendments thereof. I confirm that I have read and agree to
be bound by the Code of Professional Conduct or any subsequent amendments thereof.
I understand that my application for membership may be refused, or my membership may be later
withdrawn, if I have provided false or untrue information or if I am found not to have complied with the
Membership Regulations or Code of Professional Conduct.
Signed:
Date:
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12/2015
PAYMENT INFORMATION
Initial payment
Future payments
£40.00 – UK, Ireland and international
£60.00 – UK, Ireland and International
Please note that:
 Your initial payment may be made by cheque or debit/credit card, but cannot be paid by Direct
Debit in the first year.
 Members admitted in July, August or September, are entitled to membership until 30th
September of the following year. All subsequent subscriptions are payable annually on 1st
October.
 Payment will be processed and your application acknowledged upon receipt.
 Any charges incurred by CIEEM due to declined cheque payments will be your responsibility.
 Receipts for subscriptions and any appropriate refunds are provided at the time of admission to the
Chartered Institute.
Please tick one box and complete details as appropriate:
I enclose a cheque, payable to CIEEM for the amount of: £40.00
I wish to pay by debit/credit card, please charge to my account the amount of: £40.00
Card number:
Start date:
End date:
Name on
Card:
Issue number:
Security no:
Address of
cardholder:
Signature:
Date:
Please invoice for the amount of: £40.00
Employer’s name:
Invoice address:
Invoice Postcode:
Invoicing details
(e.g. purchase order no):
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APPLICATION CHECKLIST
Please tick the boxes below to confirm that:
You have signed the declaration and dated this application
Your sponsor has signed and dated this application
You have included the correct payment or authorisation
You have checked your application thoroughly e.g. spell check
PLEASE NOTE: APPLICATIONS WILL NORMALLY BE PROCESSED WITHIN SIX WEEKS BUT FAILURE TO
COMPLETE THIS FORM ADEQUATELY WILL DELAY ADMISSION
Please post this form to:
CIEEM, 43 Southgate Street, Winchester, Hampshire SO23 9EH
Or email it to membership@cieem.net
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