International HQ

47-58 Bastwick Street London

EC1V 3PS United Kingdom
tel: +44 (0)20 7235 4535
fax: +44 (0)20 7235 4294  
membership@istructe.org
www.istructe.org

Student Cohort Application Form  

 
 
1. Statement by Professor/Head of Department/Engineer

The person completing this section must be either the Professor or Head of the Department of the institution at which the Candidate(s) have been studying or the Engineer under whom the
candidate(s) obtained initial training.

Name:
Institution membership number (if applicable):
Email:
Position:
Name of educational establishment:
Full address:

The Institution of Structural Engineers is collecting the personal data of the individuals detailed in this workbook in order to fulfil membership of the Institution’s Student member grade as set out in
its Royal Charter, bye-laws, regulations and standing orders.

I certify to the best of my knowledge and belief: a) the particulars given by the applicant(s) are correct insofar as they relate to professional education and/or training; and b) the applicants have
provided me with their express written consent (in accordance with the General Data Protection Regulation) to share their personal data with the Institution of Structural Engineers and I have
notified them of the reasons why the Institution of Structural Engineers wishes to process their personal data and their rights under the General Data Protection Regulation.

Signature: Date:
Application Form Process

This application form is specifically designed with criteria that will assist us with electing cohort of students to student membership of the Institution, which is free of charge. To avoid any delays in
processing the form, please ensure that you review the document to ensure that all fields are completed clearly and correctly. Please refer to the example in section 2.

Please note students on non-accredited courses (e.g PhD or a non-accredited first degree) can also apply to be student members (free of charge).
2. Applicants' personal details and de

Please be aware that by completing this form you are authorising your university to forward your details to the Institution
All fields marked with * are required fields. We will not be able to elect you as a Student Member without this informati

Title* Forenames* Surname* Gender* (M/F) Email*

e.g. Mr Peter Steven Jinks M Peterjinks1@istructe.com

y to forward your details to the Institution of Structural Engineers for automatic election to student membership and further commun
a Student Member without this information and this can lead to unnecessary delays in the application process.

Date of Birth (DD/MM/YYYY)* Address 1* Address 2

27/02/1992 47-58 Bastwick Street

o student membership and further communication will be made to complete the process.
he application process.

Address 3 Town/City* County/State Postcode/Zip code Country*

London EC1V 3PS UK

HomeTelephone MobileTelephone CourseTitle*

+44 (0)20 7235 4535 BEng Structural Engineering

Course Start Date (DD/MM/YYYY)* Course End Date (DD/MM/YYYY)*

01/09/2016 0/06/2019