Chartered Institute of Ecology and Environmental
Management
Application to Upgrade from Graduate to Associate
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.
Please type in the boxes provided, remembering to check spelling and adhere to word limits where
applicable.
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
12/2015
SUMMARY OF HIGHER EDUCATION PRIOR TO ADMISSION TO CIEEM
This section must be completed fully; do not cross refer to a CV. A CV may be appended in addition.
Degree Course Title
Dates
(from – to)
Institution/Awarding Body
CIEEM
Accredited
Degree (Y/N)
Qualification and
Classification
DETAILS OF HIGHER EDUCATION SINCE ADMISSION TO CIEEM
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 degree courses transcripts or a syllabus summary listing main subjects studied and/or
details of modules taken within the degree must be included unless the degree course was
accredited by CIEEM during the period of study.
Degree Course Title
Dates
(from – to)
Institution/Awarding Body
CIEEM
Accredited
Degree (Y/N)
Qualification and
Classification
OTHER QUALIFICATIONS
Please list any other nationally-recognised relevant qualifications (e.g. diplomas, certificates) resulting from
examination or other form of assessment.
Year
Qualification
Awarding body or
organisation
Grade (if appropriate)
12/2015
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.
Membership category
(if relevant)
Professional body
Date accepted into this
category
DETAILS OF CURRENT PROFESSIONAL ACTIVITY
Current Employment Status
(e.g. Self-employed, employed, volunteer)
Position
(if relevant)
Employer
Full/Part time?
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.
12/2015
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 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)
CONTINUING PROFESSIONAL DEVELOPMENT (CPD)
Your CPD returns will be checked when your application is assessed. If you have not recorded and
submitted your CPD please do so before you submit your upgrade application form.
12/2015
SPONSORS
Two sponsors are required to support this application and to confirm the accuracy of the information
contained within it. At least one sponsor must be an Associate (or above) member of CIEEM. The second
sponsor should ideally also be a member of CIEEM but if this is not possible they should be a member of a
similar professional body at an grade equivalent to the CIEEM Associate grade or, if this is not possible, a
professional colleague. Sponsors cannot be related to applicants.
As sponsors of this application we encourage you to read through the information available on our Sponsors
Resources web page - www.cieem.net/sponsors-resources - to ensure that you feel able to support this
application. If you would like sponsors’ information to be emailed to you please contact the membership
team via membership@cieem.net or on 01962 868626.
As a sponsor you may be in breach of the Chartered Institute’s Code of Professional Conduct (or that of
another professional body of which you are a member) if you knowingly endorse false claims of competence.
In the interests of clarity, further information may occasionally be sought from sponsors.
In order to sponsor this applicant please:
1. complete the relevant sponsor statements for all of the competencies you feel qualified to support
as evidenced by the applicant in the ‘summary of competence’ section of the form;
2. supply your personal details in the ‘Declaration by Sponsors’ section of the form and sign the
declaration statements.
Data protection:
By agreeing to act as a sponsor you will be providing CIEEM with some of your personal data. If you are a
current CIEEM member we may use this data to update our records where it differs from that which we
currently hold about you and for the duration of the applicant’s membership should your own membership
cease. If you are not currently a CIEEM member we will securely retain this information:



for the duration of the assessment and appeals processes;
for the duration of the applicant’s membership if this application is successful;
for a limited time in line with our retention policy if this application is unsuccessful.
We will only share this information with relevant parties integral to our assessment, appeals and
disciplinary processes. We will never share or sell your information to any other organisations without your
consent. We will never send you information unrelated to this application without first obtaining your
consent. Thank you.
12/2015
SUMMARY OF COMPETENCE
Applicant
With reference to CIEEM’s Competency Framework please provide evidence of your relevant skills and
experience. Associate member applicants are expected to be able to demonstrate that they have reached
the Capable1 level of competence in a total of seven competencies, one of which must be Professional
Conduct. A minimum of three of the competencies should be from the ecological/environmental list and two
from the transferable list (other than Professional Conduct)
More information about how to complete this section of the application form, including the STARE method,
is available in our Detailed Guidance Document.
Please note that there is a maximum of 250 words per competence and a minimum of 100 words. Use the
drop down boxes to select your competency choices and ensure you structure your evidence using the STARE
method.
Sponsors
Please state beneath the evidence for each competency why you consider the applicant is suitable for
Associate membership of CIEEM. With reference to the applicant’s choices of competency from the
Chartered Institute’s Competency Framework, please comment on their evidence of competence as
described on this application form at the Capable level, and confirm whether or not you are in agreement
with each of these.
Competency 1
Competency
Professional Conduct:
(Mandatory)
Transferable
Level
Transferable
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
1
Has the knowledge and experience essential to carry out standard tasks unsupervised confidently and consistently well. Is likely to
need to seek advice before carrying out complex or non-standard tasks.
12/2015
Competency 2
Competency
Transferable
Choose an item.
Transferable
Level
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
Competency 3
Competency
Transferable
Choose an item.
Transferable
Level
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
12/2015
Competency 4
Competency
Ecological/environmental
Choose an item.
Ecological/Environmental
Level
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
Competency 5
Competency
Ecological/environmental
Choose an item.
Ecological/Environmental
Level
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
12/2015
Competency 6
Competency
Ecological/environmental
Choose an item.
Ecological/Environmental
Level
Capable
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
Competency 7
For your final competency choice you can choose either an Ecological/environmental or Transferable
competency. Please make your selection from one of the two drop down lists in the left hand column.
Competency
Ecological/environmental or Transferable
Level
Choose an item.
Choose an item.
Capable
Choose an item.
Relevant Evidence
(minimum 100 – maximum
250 word limit)
First sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐ I confirm I have read and agree with the statements provided for this competency.
☐ I am unable to endorse the statements provided for this competency.
Second sponsor statement in support of competency (approximately 100 - 150 word limit)
Please provide your sponsor statement below:
☐
☐
I confirm I have read and agree with the statements provided for this competency.
I am unable to endorse the statements provided for this competency.
12/2015
DECLARATION BY SPONSORS
FIRST SPONSOR
Name:
Position:
Yes ☐
Are you a CIEEM member?
No ☐
Capacity in which you know the
applicant: (e.g. colleague, manager)
Qualifications/ professional
memberships: (e.g. BSc, MSc, CEnv,
CEcol, MCIEEM)
Address:
Postcode:
Email:
Tel:
As a sponsor of this applicant you are asked to confirm that:
a) you have read the CIEEM Competency Framework, Code of Professional Conduct and the
☐
Membership Regulations – available on our Sponsors Resources webpage
b) you consider the applicant to be a person of integrity and that he/she is suitable for election to
the grade of Associate membership;
☐
c) to the best of your knowledge the applicant has practised, currently practises and is likely to
continue to practise in a manner which accords with the principles and objectives of the
Chartered Institute’s Code of Professional Conduct;
d) to the best of your knowledge all the information contained in the application is accurate.
Signed:
☐
☐
Date:
OFFICE USE
Sponsor approved:
Comments requested:
Comments received:
12/2015
SECOND SPONSOR
Name:
Position:
Yes ☐
Are you a CIEEM member?
No ☐
Capacity in which you know the
applicant: (e.g. colleague, manager)
Qualifications/ professional
memberships: (e.g. BSc, MSc, CEnv,
CEcol, MCIEEM)
Address:
Postcode:
Email:
Tel:
As a sponsor of this applicant you are asked to confirm that:
a) you have read the CIEEM Competency Framework, Code of Professional Conduct and the
☐
Membership Regulations – available on our Sponsors Resources webpage
b) you consider the applicant to be a person of integrity and that he/she is suitable for election
to the grade of Associate membership;
☐
c) to the best of your knowledge the applicant has practised, currently practises and is likely to
☐
continue to practise in a manner which accords with the principles and objectives of the
Chartered Institute’s Code of Professional Conduct;
d) to the best of your knowledge all the information contained in the application is accurate.
☐
Signed:
Date:
OFFICE USE
Sponsor approved:
Comments requested:
Comments received:
Whilst we prefer a signed hard copy of the sponsor form, we understand this is not always possible. Scanned or
electronic signatures will be accepted, however, to enable the application to be processed, we will confirm your
sponsorship of the applicant for Associate Membership via your personal email account.
12/2015
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
Associate 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:
12/2015
PAYMENT INFORMATION
The annual subscription fee for Associate membership is £120 (£72.00 for Ireland or £60.00 international).
If you are upgrading at the time of renewals you will have to pay the full amount. If you have already
renewed you will only have to pay the supplementary subscription payment of £75.00 (£27.00 for Ireland,
£15.00 outside UK and Ireland). This upgrade supplement includes a non-refundable £15.00 (inc VAT)
administration fee.
Please note that:
 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 will be provided after the application has been reviewed by the Membership Admission
Committee. .
 Should your application be unsuccessful or withdrawn your upgrade fee will be refunded.
Please tick one box and complete details as appropriate:
I enclose a cheque, payable to CIEEM for the amount of: £75.00 (£27.00 for Ireland, £15.00
outside UK and Ireland)
I wish to pay by debit/credit card, please charge to my account the amount of: £75.00 (£27.00
for Ireland, £15.00 outside UK and Ireland)
Card number:
Start date:
End date:
Name on
Card:
Issue number:
Security no:
Address of
cardholder:
Signature:
Date:
Please invoice for the amount of: £75.00 (£27.00 for Ireland, £15.00 outside UK and Ireland)
Employer’s name:
Invoice address:
Invoice Postcode:
Invoicing details
(e.g. purchase order no):
12/2015
PROFESSIONAL INDEMNITY AND PUBLIC LIABILITY INSURANCE
Members of CIEEM are required to ensure that they are insured for any work they might undertake. In many cases
this requirement will be satisfied by your employer. Where this is not so, members – especially applicable for those in
consultancy practice – are required to have adequate insurance cover, usually Professional Indemnity and Public
Liability. You may be required to show proof of this from time to time. The CIEEM scheme – only available to Fellows,
Full Members, Associate and those in retirement – is highly recommended. Details of the scheme are made available
to all new members and you can apply on approval of your membership.
APPLICATION CHECKLIST
Please tick the boxes below to confirm that:
You have signed the declaration and dated this application
Your sponsors have signed and dated this application, and if they are not CIEEM
members you have enclosed a copy of their CV’s
You have enclosed photocopies of your degree certificates (if applicable)
You have included a transcript or list of your degree modules (if applicable)
You have submitted/enclosed a copy of your CPD record
You have included the correct payment or authorisation
You have spell checked your application
You have completed answers where applicable within the required word limits
PLEASE NOTE: PROCESSING OF THIS APPLICATION TAKES A MINIMUM OF THREE MONTHS AS PART OF
THE PROCESS REQUIRES YOUR NAME TO BE PUBLISHED IN OUR QUARTERLY E-NEWSLETTER.
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
12/2015