Application for CITPM(Associate)
(For non-ISS ITPM Exam Applicants)
SINGAPORE COMPUTER SOCIETY CERTIFIED IT PROJECT MANAGEMENT PROGRAMME
APPLICATION FORM (FORM PM1)
(To help you complete the application, it is essential that you read the Guidelines. Applications with incomplete and/or missing information will not be considered)
(Please print in BLOCK LETTERS) PART 1: PERSONAL DATA Name: Mr/Ms/Mdm/Dr: __________________________________________________________________
(Please underline surname)
NRIC No./ Passport No.: _______________________ SCS Membership No.: _______________________
(Please indicate “Applying” if not a member)
Home Address: ___________________________________________________________________________ _________________________________Country: ______________________ Postal Code: ______________ Tel: _______________ (O) __________________ (H) _________________ (Pg) Fax: __________________ E-mail: _____________________________________________________ Date of Birth: _________________
PART 2: PRESENT OCCUPATION Title/Position: _____________________________ Organization: __________________________________ Organization Address: _____________________________________________________________________ Country: _____________________________________________ Postal Code: ________________________
PART 3: EDUCATION
(Print Full Name of Institution)
Qualification Received
Major Subject
Year of Completion
Institution
PART 4: PROFESSIONAL MEMBERSHIP Are you a member of SCS? Yes Applying for SCS membership (Please see enclosed membership form) If yes, please furnish Membership No.: ________________________ Grade: ________________________ Other Professional Membership Information: Professional Body Membership Grade Year Joined
Application for CITPM(Associate)
(For non-ISS ITPM Exam Applicants)
PART 5: PROFESSIONAL CONTRIBUTION Please furnish information on your Professional Contribution (e.g. thesis, papers published in Journals, please attach a copy) Description of Item Accomplished Date Completed
PART 6: PRESENT & PAST EMPLOYMENT
(In chronological order)
Years of professional practice in IT : _____________ Years in IT Project Management: _______________ Description of current job’s roles & responsibilities: ____________________________________________
(If insufficient space, please attach separate sheet detailing your job responsibilities)
Year
Job Title
Organization
________________________________________ Name of Employer PART 7: PROJECT INFORMATION
_______________________________________ Signature of Employer
I verify that the applicant’s information is accurate
Please name the LARGEST PROJECTS you have undertaken Project Duration Breakdown of Project Cost Hardware No. of Project Description Services Others (i.e. &/or Man- Start date End date (eg. Application Maintenance, Software Years (mm/yy) (mm/yy) development etc) training )
licenses
1
2
3
PART 8: PARTICULARS OF REFEREE First Referee (Current Employer: Please attach letter of recommendation from your employer) Name: Mr/Ms/Mdm/Dr: ________________________________________________ Male Female
(Please underline surname)
Title/ Position: _____________________________ Office No.: _____________ Home No.: _____________ Organization: _____________________________ Fax No.: _____________ Pager No.: ______________ Organization Address: ________________________________ Email Address: _______________________ ____________________________________ Country: __________________ Postal Code: _______________
Application for CITPM(Associate)
(For non-ISS ITPM Exam Applicants)
Second Referee Name: Mr/Ms/Mdm/Dr: ________________________________________________ Male Female
(Please underline surname)
Title/ Position: _____________________________ Office No.: _____________ Home No.: _____________ Organization: _____________________________ Fax No.: _____________ Pager No.: ______________ Organization Address: __________________________________ Email Address: _____________________ ____________________________________ Country: __________________ Postal Code: _______________ PART 9: FEES
(Information on fees can be found on the SCS Website at www.scs.org.sg)
Enclosed is my crossed cheque made payable to “Singapore Computer Society” Bank: ________________________ Cheque No.: _______________________ Amount: ________________
PART 10: CHECKLIST 1. 2. Have you completed Forms PM1 and PM2? Have you attached 3 sets of all the following documents? PM1 and PM2 Project Experience Report Letter of Recommendation from Employer Educational Certificates Curriculum Vitae Have you provided information on 2 Referees in Form PM1? Have you obtained your Employer’s endorsement by signing on Form PM1? Have you attached the correct fee to your application? If you are a non-member, have you submitted your SCS membership application together with the certification application?
3. 4. 5. 6.
PART 10: DECLARATION I certify that I have read and understood the instructions, and that the information supplied is correct to my best knowledge. I understand that any misrepresentations or incorrect information provided can result in discipline, including suspension or revocation of certification. I also understand that information submitted may be disclosed whether partial or in whole, to the relevant parties for assessment.
_____________________________ Name of Candidate
__________________ Date