UKIC Fast Track Accreditation
Draft Candidate Application Form

APPLICATION FORM

CANDIDATE

1. CANDIDATE

Surname:
First name:
Title:

2. CONSERVATION SPECIALITY

(please refer to this list of specialisms)

          

3. CORRESPONDENCE

HOME WORK
Address:
 
 
 
 Address:
 
 
 
Telephone No.: Telephone No.:
Facsimile No.: Facsimile No.:
e-mail: e-mail:
For correspondence please indicate contact number: home/work

4. FEE AND DOCUMENTS

The following have been submitted in support of the application:
Fee
Sponsors Forms
Self Assessment Questionnaire

ADMIN

Application Number:
Date Received:
Date Acknowledged:
UKIC Membership:
Assessment Committee:
Case Officer 1:
Case Officer 2:
Additional sponsor:
Accreditation outcome:
Candidate informed:

5. EDUCATION AND TRAINING

CONSERVATION TRAINING
(If course has not been full time please state number of hours/week and number of weeks/year)
College/University/Other Course (please state if full or part time) Degree/Qualification Dates
       
       

OTHER QUALIFICATIONS
College/University/Other Course Degree/Qualification Dates
       
       

INTERNSHIPS AND POST CONSERVATION TRAINING
Institution/Course/Exchange Programme Degree/Qualification Dates
     
     
     

6. EMPLOYMENT HISTORY

(List all conservation employment beginning with present position. Include self-employment history)
Employer name Position Line manager Dates
       
       
       
       
       

7. MEMBERSHIP

Organisation Membership class Year Joined
     
     
     
     
     

8. CONSERVATION REPRESENTATION

(e.g. UKIC Archaeology Section Committee)
Society/Committee Role Dates
     
     
     
     
     
     

9. AWARDS

Award Date
   

10. CONSERVATION REGISTER

Registration Number Date of Registration
   

11. PUBLICATIONS

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

12. SPONSORS

Name Organisation
1.  
2.  

13. DECLARATION

I declare that the information I have provided is a true and accurate statement of facts.
I confirm that I adhere to the Code of Ethics and Rules of Conduct of UKIC and I am committed to continuing professional development.

Signed:__________________________________________     Date:______________________

Please send completed application form and all supporting documents to:

Accreditation Committee
UKIC
109 The Chandlery
50 Westminster Bridge Road
London
SE1 7QY

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