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The Uganda Institution of Professional Engineers Application Form Newest Revised 5

This document contains an application form for membership or transfer to a class of membership with the Uganda Institution of Professional Engineers. The form requests general information about the applicant such as name, date of birth, nationality, gender, academic qualifications, engineering discipline, place of work, and contact information. It also asks the applicant to select the class of membership they are applying for and sign an obligation and certification. For membership applications, the form requires a proposer and seconder who must be members of the institution in good standing within the same engineering discipline as the applicant. Student member applications require approval from the applicant's university or technical college.

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OVURUTHO PIUS
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181 views4 pages

The Uganda Institution of Professional Engineers Application Form Newest Revised 5

This document contains an application form for membership or transfer to a class of membership with the Uganda Institution of Professional Engineers. The form requests general information about the applicant such as name, date of birth, nationality, gender, academic qualifications, engineering discipline, place of work, and contact information. It also asks the applicant to select the class of membership they are applying for and sign an obligation and certification. For membership applications, the form requires a proposer and seconder who must be members of the institution in good standing within the same engineering discipline as the applicant. Student member applications require approval from the applicant's university or technical college.

Uploaded by

OVURUTHO PIUS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE UGANDA INSTITUTION OF PROFESSIONAL ENGINEERS

APPLICATION FORM FOR MEMBERSHIP

Management Support Unit Building,

Public Works Training Centre,


Plot 2, Gloucester Avenue, Kyambogo
P.O. Box 1308, KAMPALA
Tel: 256-414-287292

Email: [email protected]/ Website: www.uipe.co.ug

Revised on……11th…………...Day of ………October……….…….2022


APPLICATION FORM FOR MEMBERSHIP OR TRANSFER TO CLASS OF
MEMBERSHIP

Please read guidelines attached before filling in this form

1. GENERAL INFORMATION

Name in full: Surname first: …………….………. Middle Name: …………………...First


Name: ……………………….

Date of Birth: ………………………………………………

Nationality: ………………………… Gender ……………………….

Academic Qualifications
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………
Engineering Discipline……………………………………….…………………

Place of work ……………………………………………………………………….

City/Town name ……………………………………….

Street Name ……………………………………………...

Plot No. ………………………………………………….

Tel: +256………………... Email: ……………………………………………………...

UIPE Branch Membership: …………………………………...

Application route for Membership (please tick) (Applicable for Members)

Projects, Academia Mutual recognition (East Africa)  Mutual Recognition


(Commonwealth)  Temporary Registration

1
Membership Class you are applying for (please tick only one): (another class of membership
was created for Corporate Companies)

Technician Technologist Student Graduate Member Fellow Honorary Corporate


(for companies only) 

2. OBLIGATION AND CERTIFICATION

I, the undersigned, agree that in the event of my admission to the class of membership in the
Uganda Institution of Professional Engineers, I will be governed by the constitution and bye-laws
of the Institution, as they now are, or as they may hereafter be altered, and that I will advance the
objectives of the Institution as far as shall be in my power, provided that whenever I shall signify
in writing to the Honorary Secretary that I am desirous of withdrawing. I shall, after the payment
of any arrears which may be due by the period, be free from this obligation. I certify that the
statements given above are correct.

Signature: Date:

3. PROPOSER (Must be a Member of UIPE and in good standing and Must be same
discipline as the applicant). (This is not applicable for student member applicants)

I, the undersigned, having read the form and report (where applicable) hereby propose/support the
candidate from personal knowledge as a person worthy of admission in the class of membership
applied for and I certify the correctness of the parts I have initialed. “I am fully aware that
proposing an applicant without reading the reports will be considered unethical and bad
professional conduct.

Signed: Class of Membership:(Member or Fellow)

Names in block letters

Engineering Discipline……………………………………………………………………...

Address for communication:

Tel: .................................. Email: …………………………. Date…………………………

2
4. SECONDER (Must be a Member of UIPE and in good standing and Must be same
discipline as the applicant). (This is not applicable for student member applicants)

I, the undersigned, having read the form and report (where applicable) hereby propose/support the
candidate from personal knowledge as a person worthy of admission in the class of membership
applied for and I certify the correctness of the parts I have initialed. “I am fully aware that
proposing an applicant without reading the reports will be considered unethical and bad
professional conduct.

(Signed: Class of membership: :(Member or Fellow)

Name in Block letters:

Address for communication:

Engineering Discipline…………………………………………………………………

Tel…………………………… Email………………………… Date………………………

(Mentor should be of your engineering discipline)

5. APPROVAL BY THE UNIVERSITY OR TECHNICAL COLLEGE (for student


members only)

Name of University or Technical College………………………………………………...

Department…………………………………………………………………………….

Name of Dean or Head of Department: ……………………………………………….

Signature……………… ……Date…………………………. Stamp………………………

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