Membership Application Form

Chartered Institute for the Management of Assessment Practice

Please complete this application form and submit by fax or e-mail with your proof of payment. Fax 086 762 9357 / e-mail to admin@cimap.co.za Banking Details - For Audit trail purposes please pay directly to CIMAP's Accountants: Ref: CIMAP MFD Financial Services ABSA Cheque Account - Branch 632005 Account number: 406 994 1796 I herewith apply for membership of CIMAP. I confirm by submission of this application that I have read the code of conduct and terms and condition of membership. Please Note: All new applicants will be awarded affiliate members status. Applications for higher designations will be confirmed on application by the membership status subcommittee. Surname First Names Title (Dr, Mr, Mrs, Ms etc) Identity Number(Please submit a copy of your ID) Professional Qualifications (Please submit proof of your stated qualifications) Company Name (If applicable) Physical Address Postal Address E-mail address Telephone number Cell number

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Fax Number

What are your specialisation?

ETD

areas

of Facilitation Assessment Moderation Coaching Project (learnership) management Materials Development

Do you belong to any other Yes professional body or association? Please specify.

No

If you are a constituently registered ETQA assessor, list the ETQAs where you have constituency. (Please submit relevant documentation as proof of registration in support of your application).

Qualifications against

registered

(As per report attached) (As per report attached) (As per report attached)

If you are a moderator, list the ETQA ETQAs where you have constituency.

Qualifications

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(Please submit relevant documentation as proof of registration)

Please indicate in which sectors you consider yourself an expert?

Agriculture Engineering Legal Real Estate Practice Social developmen t Sports and Recreation

Arts & Entertainme nt Banking and related services Communicat ion

Food and Beverage

Local Government

Finance and Accounting

Manufacturi ng

Health Safety

&

Managemen t

Wholesale and Retail

Cleaning

Hospitality and Tourism H. R. Health Welfare &

Marketing

Chemical Constructio n

Mining Project Managemen t Public service Public Relations Quality Managemen t

Design and fashion Education

Insurance

IT

Entrepreneu rship and Innovation Other:

Labour Relations

I hereby give permission for my membership status and areas of specialisation to be made available to third parties. (This service includes distributing my constituent status to membership companies and other professional

Yes

No

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bodies / associations, regulators etc. that may want to contract the services of independent assessors and moderators)

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Membership
Affiliate Membership Annual Fee Please indicate

Affiliate Membership for 1 Renewable each year in joining month year: Assessors that are not at normal annual fee of R 600.00 constituently registered by an ETQA Affiliate Membership Renewable each year in joining month (renewal) : Constituently at the current annual fee of R 400.00 Registered Assessors with an ETQA (First year of registration) Affiliate Membership (new): New member offer of R 280.00. Constituently Registered Assessors with an ETQA (First Time Membership not for applicable renewals). Affiliate Corporate Membership (Must be in the process of registering with DHET as a FET College). Renewable each year Current annual fee of R 500.00

Chartered Corporate Renewable each year Membership (must be Current annual fee of R 1200.00 registering with DHET as a FET College). Banking Details - For Audit trail purposes please pay directly to CIMAP's Accountants: Ref: CIMAP MFD Financial Services ABSA Cheque Account - Branch 632005 Account number: 406 994 1796

Professional designations Please note that professional status designations information is available on our web site: http://cimap.co.za/professional-designations.htm . CIMAP members will receive

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detailed information regarding the cycle professional designation application process in their membership confirmation pack. Professional designations are awarded and must be maintained through the participation of Continuous Professional Development (CPD) activities on an annual basis. Please note: If your evaluation for a higher designation is not successful, you will automatically be accepted as an Affiliate Member. Affiliate members will be provided with a personal development plan to assist you in planning for your future development.

Undertaking of Commitment I, the undersigned, agree that, by becoming a member of the Chartered Institute for the Management of Assessment Practice (CIMAP), I will adhere to the CIMAP Constitution and the Code of Conduct and undertake to support the principles and objectives of CIMAP. I certify that statements made in this application and supporting documentation is true and correct.

Signature

Print Name

Date

For Office Use:

CofC

Received

Replied

Mailing List

Important
Please ensure that you read the Code of Conduct before signing your application. You are signing to commit to adherence to the standards of conduct, competence and practice as set out in this Code, and an ongoing commitment to your personal self-development and the requirements of CIMAP.

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CIMAP Membership Code of Conduct

The Chartered Institute for the Management of Assessment Practice (CIMAP) is the chartered professional body dedicated to supporting individuals to achieve success through higher standards in assessment, education and training practices. Its objectives are to promote for the benefits of its members and the public the practice of education, training and development and to advance public education in the role of the assessor, moderator, facilitator and instructional designer in the economic and socio-economic environment. This Code sets a high standard of professionalism and CIMAP provides support and advice to members as they strive to embed the code in their day-to-day professional activities. The principles underlying this Code are:

Management of self; Management of others; Management of clients; Management of business partners and colleagues; Service to the wider community; Support of the professional body.

When managing myself I will:

Strive for excellence at all times; Exemplify high standards of professional behaviour and performance; Be accountable for my actions; Disclose anything that may create conflict of interest and maintain high ethical standards; Act only within my level of competence;

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Continue to develop my competencies and keep up to date with best practice.

When managing others I will:

Treat everybody on an equitable basis, with no discrimination, recognizing their individual needs and responding accordingly; Support my immediate team and others to fully understand their responsibilities, areas of authority and accountability; Empower my immediate team by facilitating the development of skills and qualities evident within the team and recognize their achievements; Foster a culture of transparency and address issues in a frank and timely manner; Communicate effectively, openly and clearly.

In my dealings with clients and their companies, I will:

Uphold internal policies and practices in the interest of good practice; Reconcile my personal values with those of the client and the company; Be accountable for achieving the objectives, projects and tasks that I undertake to deliver; Safeguard the reputation and assets of the organisation; Exhaust all available internal remedies for dealing with matters I perceive to be improper before resorting to public disclosure.

When interacting with stakeholders I will:

suppliers,

business

partners

and

other

Ensure that I clarify their interests and respond to them in a balanced and ethical manner;

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Establish, develop and maintain business relationships based on mutual confidence and trust; Refrain from entering into any agreement that is unlawful or unethical; Neither offer nor accept gifts, hospitality or services which could create, or imply improper obligation; Safeguard all confidential information, which comes into my possession.

Within my community, I will:

Ensure that I am aware of, and comply with all relevant legislation and

regulations;
Act to avoid or mitigate any adverse outcomes, of present and proposed

managerial actions;
Be honest, open and truthful in all external communications; Respect the environment and seek to conserve resources wherever

possible;
Respect the customs and practices where these may differ from my

own.

As a member of the Chartered Institute for the Management of Assessment Practice, I will:

Promote its mission, aims and objectives; Uphold its integrity and good standing, and refrain from conduct that will bring it into disrepute; Promote its image and standing as a professional body; Support the bodys initiatives for continuous professional development and lifelong learning;

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Observe the standards of conduct as set out in this Code, and re-sign my commitment as they change from time to time.

Signature

Date

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