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Student-Form-1

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15 views

Student-Form-1

Uploaded by

blesskhidkartel18
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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GHANA INSTITUTION OF ENGINEERING

Engineering Centre, 13 Continental Road, Roman Ridge, Accra. Digital Address:


GA-088-0381, P.O. Box AN 7042, Accra-North, Ghana, Telephones:-(233-21)-760867/8,
Fax:-(233-21)-772005, Email: [email protected]

Student Membership Application Form


Member Number
Attach 2 certified
passport size photographs

1. PERSONAL
Surname: Other Names:
Date of Birth: Age at Date of Signing:
Place of Birth: Nationality
Home Address: E-mail:

Mobile No:

ENGINEERING EDUCATIONAL UNIT

Name of Institution

Address

Course (e.g. BSc (Hons) Civil Engineering): Duration of course:

Expected Year of Graduation: Stage Reached:

I hereby certify that the applicant is registered in an Engineering Educational Unit and is being educated
and/or receiving training in engineering science. (Article 8.3.4(C))

Name Signature of Applicant

Signature of Head/Principal/Dean/Provost of Engineering Educational Unit

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