Membership Application Form

Indicate Grade:

Graduate Member Technician Technologist Engineer Associate Member

Read the notes overleaf before completing this form Member Number

1.PERSONAL INFORMATION

Surname: / Sex:
Other Names / Title (Dr/Mr/Mrs/Miss/Other)
Place of Birth / Date of Birth
Nationality: / Business Address
Address for communication (if different) / Business Email
Personal email / Home telephone:
Business Telephone

2.ACADEMIC QUALIFICATIONS

Attach certified copies of certificates

Date / Name of Institution /College / Course of Study / Years of Attendance / Qualification Attained
From / To

3.REFEREES/SUPPORTING INFORMATION :

This section is to be filled by your supporters(2) who can be your Employer, a member of the IER (Engineer, Technologist or Technician) or someone that knows you in a work capacity provided that he /she has an engineering registration status or engineering background.

No / Full Names / Category of Membership / Registration number / Other (Line Manager/Lecturer) / Contact Information
1
2

In my opinion this person has achievedthe required knowledge and understanding and is a suitable candidate to become a registered Technician/ Technologist/Engineer by the Institution of Engineers Rwanda.

Signature of Supporter (1)……………………………………….Signature of Supporter (2)…………………………….

Date ………………….Date………………………

4.ENGINEERING CAREER:

You must provide a statement (2500-3000 words) neatly typed and presented in chronological order, beginning with the earliest date, on the way your engineering career has developed. This should include; an outline of work in which you have been personally engaged; A statement of your professional responsibilities; an outline of the form of the organisation in which you hold the above responsibilities; your relationship with others of your rank. Your statement should show any specialised services available to you but not under your direct control. If engaged in research and development or in circumstances where results of your work are published, a list of available reports, or papers of any patents should be provided. If you are a design engineer, details of any important designs originated by you and details of any patents should be provided. The details that you give should be sufficient to indicate the type of engineering with which you were concerned and the level of responsibility or degree of supervision given to your work.

5.OTHER TRAININGS ATTAINED

Give a full and complete record of your training in engineering. Specify the actual area of engineering practice; e.g. Civil/Electrical/Mechanical Foundry practice, Machine Shop, etc. If experience is being offered in lieu of formal training please break this down as far as possible under the classification given. If you undertook a research program rather than formal training you should ensure that the design and manufacture aspects are fully detailed.

1
Mention Dates Chronological order / 2
Course Title and training Description / 3
Award (give details) / 4
Awarding Body
From To

6.MEMBERSHIP/PROFESSIONAL REGISTRATION WITH OTHER PROFESSIONAL BODIES

1.
2.
3.
4.

7. DECLARATION

I declare that the statements made on my application form are to the best of my knowledge true. I agree to comply with thelaw N° 26/2012 of 29/06/2012 governing the profession of engineering and establishing the Instituteof Engineers Rwanda(IER), theInternal Rules and Regulations and the Code of Ethics.

I will do my best to promote the interests of IER. I confirm that I have not committed anyoffence of which IER would require me to give notice under its Rules of Conduct. I understandand consent that the information provided on this form be processed byIER for its sole use.

Signature of Applicant: ------Date: ------

FOR OFFICIAL USE ONLY

Membership Committee Recommendations:

RECOMMENDATIONS:

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2
3

Governing Council Approval

Date …………………………………………………………………………………………………………………………………….

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