Application for Academic Fellowship of The

Application for Academic Fellowship of the

Landscape Institute

The information note which accompanies this application form gives important information about how your application will be considered and the documentation you are asked to supply. Please read it carefully before making your application.

Your details

First name
Last name
Title
Address
Daytime Tel No.
Email address
LI Membership No.

Included with Your Application

There is detailed guidance about the following inclusions in the ‘Information Note for Applicants’ available from http://www.landscapeinstitute.org/membership/fli.php

Please submit one copy of all documents, including this application form, on a single CD or by email to . Paper copies cannot be accepted.

¨  I have enclosed a Curriculum Vitae of a maximum of two sides of A4, detailing my relevant professional experience.

¨  I have enclosed a statement concerning my Continuing Professional Development (CPD) totaling not more than two sides of A4

¨  I have included a personal statement in support of my application for Fellowship of a maximum of two sides of A4.

¨  I have enclosed a portfolio or summary of my most relevant professional work for the Board’s consideration. This is no larger than A3 format and does not exceed 20 pages.

Higher Education and Training

Please list, in chronological order, the relevant academic and vocational qualifications you have obtained to date and any other periods of relevant training you have undertaken which you feel may be relevant to your application for Fellowship or Academic Fellowship of the LI. For each, where applicable, give the full title and level of qualification obtained and the date conferred. Please note that to assist the Fellowship Admissions Board you are asked to complete this section even if this information is provided on your CV.

Title of qualification and level of attainment eg BSc Ecology / University, College or other institution / Date conferred

Continue as needed.

Research, Publications and Prizes

Please give details of any academic research you have undertaken, either working independently or as part of a research group, and details of any relevant publications, awards, grants or prizes. Please note that to assist the Board you are asked to complete this section even if this information is provided on your CV. Please leave blank if not applicable.

Continue as needed.

Professional Membership and Decorations

If you are a member of any other relevant professional bodies or learned societies, either in the UK or in another country, or hold any designations or decorations, please give details below. Please note that to assist the Board you are asked to complete this section even if this information is provided on your CV.

Professional body, society or other institution / Grade, designation or decoration e.g. MRTPI / Date conferred

Continue as needed.

Proposers

In support of your application you are asked to nominate two proposers who have agreed to provide a confidential statement to the Chief Executive with regard to their knowledge of the scope and significance of your professional experience and integrity. One of your proposers must be an Academic Fellows or Fellow of the Landscape Institute; the second proposer may be either a Chartered Member or an Academic Fellow/Fellow. You should not nominate as a proposer any persons with whom you have a close familial or business relationship, or any other current relationship which could give rise to a potential conflict of interest. One proposer may be a current colleague. Letters for you to forward on to your proposers can be downloaded from:

http://www.landscapeinstitute.org/membership/fli.php.

Proposer 1 Your first proposer should themselves be an Academic Fellow or Fellow of the Landscape Institute

Name / Telephone number / Email address / In what connection is this person known to you?

Proposer 2 Your second proposer may be either a Chartered Member, Academic Fellow or Fellow of the Landscape Institute

Name / Telephone number / Email address / In what connection is this person known to you?

Data protection

The details you give of your name, contact details and the qualifications and designations on which you rely as the basis of you application will be used as the basis of your entry in the List of Members and will be recorded on the Institute’s database. The information you supply on this form will be used for automatic processing of your annual membership and for supplying you with information about the Landscape Institute and the profession. Additionally, your name and grade will be published on the Members Section (password protected) of the Institute’s website unless you indicate below that you do not wish your details to be published.

¨  I am content for my details to be published by the LI on the password protected Members Section

¨  I do not want my details published

Submitting your application

Please remember all documents should be submitted on a single CD or emailed to . Paper copies cannot be accepted.

If your application contains any large files (over 10MB) you may wish to use a free service such as www.dropbox.co.uk to transmit them to the LI.

Declaration

I, the undersigned, being a Chartered Member of the Landscape Institute, hereby apply for election as an Academic Fellow of the Landscape Institute. I declare that the statements made by me in support of this application are a true account of my professional standing, experience, education and achievements. I further declare that I shall continue to be bound by the Charter, By Laws and the Code of Professional Conduct of the Institute and that, if elected as an Academic Fellow of the Landscape Institute, I shall vigorously promote the Institute to the best of my ability. I understand that my membership shall continue until such time as I shall give written notice of my resignation.

Signed ______Date: ______

Monitoring form

The LI is committed to ensuring that the profession is accessible to all sections of the community. We monitor the profile of our membership to ensure that the Institute is compliant with equality and diversity legislation and that we carry out our work in accordance with best practice.

Please help us in this work by completing the section below. Your details will be stored on the LI’s secure database and will remain confidential.

Please note that the Institute may, from time to time, publish reports on the overall profile of the membership. These will present data in aggregated form, and will not be made available in any format which would enable you to be individually identified.

How would you describe your ethnic origin?

6

White

¨  British

¨  Irish

¨  Other (please state)

Black

¨  Black British

¨  Black Caribbean

¨  Black African

¨  Other (please state)

¨  Chinese

¨  Other (please state)

Mixed

¨  White and Black Caribbean

¨  White and Black African

¨  White and Asian

¨  Other (please state)

Asian

¨  Asian British

¨  Asian Indian

¨  Asian Bangladeshi

¨  Other (please state)

¨  Prefer not to say

6

Would you describe yourself as having a disability?

¨  Yes

¨  No

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