IMechE Associate Application Form

ASSOCIATE
application form
Step 1: Applicant details Step 2: ACADEMIC QUALIFICATIONS
All sections of this form must be typed or completed in black ink in To be completed by all applicants.
block letters. If the form is incomplete, this will delay your application Please complete details of first degree qualification.
and the form may be returned to you.
University
Designatory letters
eg BEng, OBE Degree designation
(eg BEng/MEng)
Membership number
(if already a member) Full degree title
(eg Mechanical Engineering)
Title: Mr/Mrs/Miss/Ms/Dr
Course type
Forename (eg F/T, P/T, sandwich)
Surname Which year did you enter the degree
1st / 2nd / 3rd / 4th
Date of birth
Date of admission to course
Home address
(excluding foundation year)
Date of graduation
Country If you did not start in Year 1 of the degree, please provide photocopied
evidence of qualifications awarded prior to commencing your part-time
Postcode degree (eg HNC/HND).
Home email
Degree programme transfer
Work email
Home tel If you did not complete all your studies on the programme for
the degree awarded, please supply details of your previous degree
Mobile study programme.
Are you applying for enrolment with the Institution’s MPD Scheme University
with this application? Yes No
Degree designation
(eg BEng/MEng)
Full degree title
(eg Mechanical Engineering)
Course type
(eg F/T, P/T, sandwich)
Which year did you enter the degree
1st / 2nd / 3rd / 4th
(excluding foundation year)
Date of completion of studies on this programme
Post graduate qualification (if any)

University
Degree designation
(eg MSc, PhD)
Full title of degree
(eg Aero Engineering)
Course type
(eg F/T, P/T)
Degree classification
(eg Pass, Distinction)
Date of graduation
Step 3: Data protection act Checklist
IMechE will hold your personal data (for example, your contact details, Don’t forget to enclose.
areas of engineering interest and details of your academic record Application fee. Cheques should be made payable to IMechE
and employment experience/history) on its computer database. This and crossed ‘A/C payee only’
information may be accessed, retrieved and used by IMechE and its Authenticated and translated evidence of the
associates for normal administrative purposes (for example, processing award of your degree - please see notes
your membership application/renewal and contacting you in respect If applying for MPDS, enclose registration form and payment
of your membership) and conducting market research. If you are based for MPDS registration. See website for current fees
outside the European Economic Area (the “EEA”), information about
you may be transferred outside the EEA.
IMechE may also periodically send you information on events, Please note
conferences and publications you may be interested in. If you
do not wish to receive such information, please tick this box. Photocopied evidence of your degree(s) must be submitted with this
IMechE may also provide your personal information to carefully application form. This can be in the form of a copy of your certificate, or
selected third parties (a list of whom is available on request) in order a copy of the communication received from the university notifying you
to provide you with information for non-IMechE events, conferences, of your degree award. All copies of certificates/correspondence should
publication and various affinity benefits. Where possible, the be authenticated on the front with the statement “this is a true and
information sent to you by third parties will be targeted to focus fair copy of the original” and should be signed by one of the following:
on your likely interests. However, if you do not wish to have your • The university
personal details used in this way, please tick this box. • A Chartered Engineer or Incorporated Engineer (or the equivalent
level of professional registration overseas)
• A senior in charge, or a member of the company’s HR department
Step 4: Engagement The person signing the above statement should print in block
capitals: their name, position, organisation, and registration number,
To be signed by applicant. Please read carefully. where applicable.
I, the undersigned, certify these statements are true, and do hereby

agree that in the event of my election I will be governed during my
membership by the Royal Charter and By-Laws of IMechE, as they are Membership application fee
now formed or as they may hereafter be altered, and that I will not use
any titles, abbreviated titles or descriptions associated with IMechE An application fee must accompany this form. This fee is
except those to which I am entitled under the By-Laws. non-refundable and does not include the annual subscription.
Details of our current fees can be found on our website.
I further undertake that I will pay an annual subscription as prescribed
in the By-Laws, and if at any time I shall desire to withdraw from the Applicants should note that transfer to Associate membership may
Institution, I will forthwith pay all arrears of subscription or other generate an additional subscription fee for the current year.
payments due from me.
Monitored Professional Development Scheme (MPDS)

Signature
Date You can apply for registration on the MPD scheme if your company
holds an IMechE accredited plan. Your company will be able to advise
you accordingly and ensure your mentor has completed the Mentor
Please return completed forms to: Registration Form.
Membership applications Registration forms can be downloaded from: www.imeche.org/mpds

IMechE
1 Birdcage Walk
London SW1H 9JJ
T 0845 226 9191
F 020 7090 1001
E [email protected]
Overseas callers +44 (0)20 7090 1078
www.imeche.org
For office use only

Received
1st degree evidence checked
2nd degree evidence checked
AAC ref no
Fees paid
Current academic status
Accepted date
Signed

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ASSOCIATE

Post graduate qualification (if any)

I, the undersigned, certify these statements are true, and do hereby

Monitored Professional Development Scheme (MPDS)

Membership applications Registration forms can be downloaded from: www.imeche.org/mpds

For office use only

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