EXAM APPLICATION FORM

FOR FASTER AND EASIER PROCESSING, REGISTER ONLINE AT WWW.THEIIA.ORG/CERTIFICATION.

Candidates seeking to take the CIA exam in Australia, Austria, Brazil, China, Czech Republic, France, Germany, Greece, Indonesia, Israel, Italy,
Japan, Korea, Malaysia, Morocco, The Netherlands, New Zealand, Norway, Philippines, Singapore, South Africa, Spain, Sweden, Switzerland,
Taiwan, Thailand, or Turkey should refer to page 15 for application instructions.

NAME: ____________________________________________________________________________________________________________________________________________
Last Name First Name Middle Name or Initial
Prefix (Mr., Mrs., Ms.): ______________________________________ Suffix (Jr., Sr., III, other): ____________________ Nickname: ______________________________________________
GENDER: ■ Male ■ Female DATE OF BIRTH: __________________________________________ MOTHER’S MAIDEN NAME: ______________________________________________
IIA MEMBERSHIP/ CUSTOMER INFORMATION:
Are you a member or prior customer of The IIA? ■ Yes – ID #: __________________________________ ■ No - See p. 6 for special membership offer.
SEND ALL IIA MAIL TO: ■ Home ■ Office
TITLE: ________________________________________________________________________________________
ORGANIZATION:__________________________________________________________________________________________ E-MAIL CONFIRMATION:
■ Check here if you would like to receive your exam
BUSINESS ADDRESS: ____________________________________________________________________________________ confirmation and site authorization for the exam via
your e-mail address. Exam results are not provided by e-mail.
City/State/Province: ________________________________________________________________________________________
ZIP/Mail Code/Country: __________________________________________________________________________ PREFERENCES
E-MAIL: ________________________________________________________________________________________ ■ Check here if you do not want your e-mail address used
for general IIA communications.
BUSINESS PHONE/EXT.: ________________________________________________________________________________ ■ Check here if you do not want your name included on
mailing lists other than IIA mailings.
FAX: __________________________________________________________________________________________
HOME ADDRESS: ______________________________________________________________________________ JOB CODE (see p. 19): ________________________
City/State/Province: ________________________________________________________________________________________ INDUSTRY CODE (see p. 19): __________________
ZIP/Mail Code/Country: __________________________________________________________________________ IIA AFFILIATE CODE (see p. 18): ________________
HOME PHONE: __________________________________________________________________________________________
LANGUAGE REQUESTED: EXAM DATE for which you are applying: ■ Check or money order enclosed.
■ May ■ November ■ Year: ________________ ■ Charge to my: ■ VISA ■ MasterCard ■ American Express
■ English ■ Spanish ■ French ■ Portuguese
■ Other Date: _________________________________________ Card Number: ______________________________________________
EDUCATION: (Copy of degree or transcripts must be
submitted with or directly following application.) EXAM SITE: (see listing, p. 17) Expiration Date: ____________________________________________
Highest degree attained: Code: ________________________________________________
Signature:______________________________________________________
■ Bachelor’s degree (BS, BA, BCom, etc.) City/State/Province: ____________________________________
■ Wire transfer. (Candidate’s name must be referenced on wire
Country:____________________________________________________
■ Master’s degree (MS, MA, MBA, etc.) transfer.)
FEES: Application will not be processed without payment. Date Sent: __________________________________________________
■ Doctorate
Prices are subject to change. Candidates can take as many exam
■ Other: _____________________________________ parts as they choose on any exam date. Originator: __________________________________________________
Year awarded: ______________________________
Application Fee Amount Sent: ______________________________________________
Member Nonmember Full-time Student Other
CERTIFICATIONS ATTAINED: CERTIFICATION:
(Check as many as appropriate.) ■ US $60 ■ US $75 ■ US $30* ■ _____
■ Waived (See p. 6) I hereby certify that I have read and will abide by the provisions of
■ CCSA the Code of Ethics (see p. 23) and accept all conditions of the CIA
Exam Part Fees
■ CGAP Part I ■ US $85 ■ US $110 ■ US $35* ■ _____ program.
■ CFSA Part II ■ US $85 ■ US $110 ■ US $35* ■ _____ Signature: __________________________________________________
■ CPA – State/Country:________________ Part III ■ US $85 ■ US $110 ■ US $35* ■ _____
■ CA – Country:______________________ Part IV ■ US $85 ■ US $110 ■ US $35* ■ _____ Date: ______________________________________________________
■ CMA – Country:____________________ Part IV Professional Recognition Credit
U.S. Federal ID#: 13-5532538
■ CGA (Must include documentation. See p. 4.) GST #: R124590001
■ CISA ■ US $85 ■ US $110 ■ US $35* ■ _____ Wire Transfer – Bank of America:
■ Other:_____________________________ ■ Waived (see page 5) Account #: 1330059799, Routing #: 026009593
INTERNAL AUDITING EXPERIENCE: Return to:
If paying by wire transfer, add US $15. ________________
■ None ■ Less than 1 year
In Canada, add GST/HST (see p. 17). ________________
■ 1 year but less than 2 years ■ 2 or more years
If paying by check drawn on bank outside
SPECIAL CONDITIONS: the United States and Canada, add US $30.____________
■ Check here if you need accommodations for a special TOTAL: ________________
condition (such as a disability). Include a separate letter P.O. Box 281196
stating what type of accommodations you require. Atlanta, GA 30384-1196 U.S.A.
* Student fee must be accompanied by a Full-time Student
or Fax: +1-407-937-1101
Status Form (see p. 20).
OTHER INFORMATION:
■ Check here if you have ever been convicted of a felony. If mailing by express mail, send to: The Institute of Internal Auditors,
247 Maitland Ave., Altamonte Springs, FL 32701-4201 U.S.A.
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