Membership form

Title
First Name:
Last Name:
Date Of Birth:

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Phone (Home):
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Email Address:
Current Job Title / Role
Employer
Date Appointed

Please enter your work address:Address (# and Street)
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Phone (Work):
Most Recent Qualification
Educational Institution that awarded your latest qualification
Subject Studied
Date From
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Assessment Interests
How did you find out about CIEA
Declaration

By checking this box, I confirm that the information supplied in support of my application for membership of the Chartered Institute of Educational Assessors (CIEA) is correct. If accepted to membership I agree to observe the provisions of the Institute’s Code of Professional Practice.