Attach

INSTITUTION OF ENGINEERS RWANDA one

passport
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Remera - Ingenzi House, 2nd Floor
P.o.Box 4386 Kigali Rwanda photogra
Email: engineersrwanda@gmail.com; website: hht://www.engineersrwanda.rw ph

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
[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw
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 Attach certified copies of certificates
Date Name of Institution Course of Study Years of Attendance Qualification Attained
/College 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.

N Full Names Category of Registration Other (Line Contact Information

o Membership number Manager/Lecturer)
1
2

In my opinion this person has achieved the 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………………………

[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw

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 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.

[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw

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

From
To

[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw

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 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 the law N°
26/2012 of 29/06/2012 governing the profession of engineering and establishing the Institute of Engineers Rwanda (IER), the Internal 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 any offence of which IER would require me to
give notice under its Rules of Conduct. I understand and consent that the information provided on this form be processed by IER for its
sole use.

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

[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw

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 FOR OFFICIAL USE ONLY

Membership Committee Recommendations:

RECOMMENDATIONS:

Governing Council Approval

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

[Tel:0783251948,0788594136 : email : engineersrwanda@gmail.com ; web site: ht ://www.engineersrwanda.rw

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