RSci application

Personal Information

Consent for storing submitted data *

Yes, I give permission to store and process my data

See our Privacy Policy listed on our website.

First Name(s) *

Last Name *

Date of Birth *

Home Address *

Including postcode

Home Phone

Home Email *

Professional Information

Work address *

Including postcode

Work Phone *

Work Email *

Academic Qualifications

Institution *

Qualification *

Subjects *

Class/Grade *

If applicable

Please upload copy of certificate *

Additional Qualification

Institution

Qualification

Subjects

Class/Grade

If applicable

Additional Qualification 2

Institution

Qualification

Subjects

Class/Grade

If applicable

Additional Qualification 3

Institution

Qualification

Subjects

Class/Grade

If applicable

Other memberships and registrations

IPEM Membership Number *

Date joined

If known

Existing designations (eg EngTech):

Membership of other professional or learned bodies

RCT Number

If applicable

Date IPEM Diploma awarded

If applicable

Supporter Details

First Name *

Surname *

Email *

Job Title *

Professional Background *

Please provide details of your supporter's relevant registrations (including registration number), professional body memberships and highest qualification level

Relationship to you *

What professional relationship does your supporter have to you?

Additional Information and Supporting Documents

Please upload any additional documents you wish to provide to support your application (e.g ENIC statement, certificates)

Declaration

I wish to apply for registration, via IPEM, as a Registered Scientist Technician and declare that the information I have given in this application is, to the best of my knowledge, accurate and true. I agree to maintain my competence through continuing professional development (CPD) by participating in IPEM’s CPD scheme, making an annual declaration of my CPD activity and making my full CPD record available for audit whenever required. I also agree to observe the Code of Professional and Ethical Conduct issued by IPEM and accept that any breaches of the Rules of Professional and Ethical Conduct will be dealt with under IPEM’s disciplinary procedures. *

Signed