Training Agreement Application Form

ICE 3142
If your Company has signed up to the online process, you can apply online at the same time as making your application for Graduate Membership at: www.ice.org.uk/ta Please consult MGN 31 which is available on the ICE website before making your application.

Trainees Personal information:

ICE Membership No: Surname: First name(s): Current Grade: Title: Date of Birth:

Trainees Office Address:

Company name: Address Line 1: Address Line 2: Address Line 3: Country: Postcode: Telephone: Fax: Work E-mail: Job title:

Supervising Civil Engineer (SCE) information:

ICE Membership No: Surname: Signed: Title: First name(s): Date:

Trainees Academic Qualifications (Undergraduate and Post Graduate)

Awarding University/College
(in order attained)

Course Details
Please list title of award (MEng, BEng etc), full time, part time and level (ie. Hons, Pass etc)

Class
(1st, 2;i, etc)

Start Date
(mm/yy)

End Date
(mm/yy)

Training Details:
Training Start Date: (dd/mm/year)

Important undertaking to be signed by:

Employer We undertake to provide the trainee with the opportunities for Approved Training either within the organisation named above or by secondment to other organisations. The trainees employment for the period of the training will depend on satisfactory work and conduct, and on conditions of business allowing training to be provided. We undertake to notify the Institution if this Agreement is transferred, suspended or cancelled. Signed: Date: Notes: 1. Applicants should keep the original of this Form (both pages if payment is made by Credit or Debit Card has been selected) and submit a copy to ICE. This will not be returned after registration. email cats@ice.org.uk when you have paid online. ICE BACS details are: HSBC, Account Number 00049255, Sort Code 40-20-80, Account name Institution of Civil Engineers. You MUST add your name/membership number as a reference (eg ICE 87643215). 3. 4. If you are not paying by Credit/Debit card please DO NOT submit page 2 of this Application Form. You may apply by mail, fax or email (scanned copy). Addresses are provided on Page 2. Trainee I undertake to draw full benefit from the opportunities of Approved Training to be provided by my employer named above, and to observe the advice of the Supervising Civil Engineer for the full period of training. I will record my work experience. I undertake to maintain my membership of the Institution of Civil Engineers. Signed: Date:

2. Payment is expected to be included with this application or to be done online via http://www.ice.org.uk/fees but please

For office use only

Date Registered: Fee Received:

Initial Professional Development ICE3142

Yes

Initials:
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- If you are not paying by Credit or Debit Card, do not return this page Fee and Payment Options A fee of 371.00 is applicable per trainee registered under an ICE Training Agreement. Payment must be received before a trainee can be registered. You may also pay online via http://www.ice.org.uk/fees then please advise cats@ice.org.uk by email, thank you. Payment by Company or Personal Credit/Debit Card Trainees Name: Membership No:
(If applicable)

CREDIT/DEBIT CARD No:

(we do not accept AMEX, Diners Club, Electron or Solo)

Cardholders Name: Expiry Date:

SWITCH/MAESTRO CARD No:

(UK account holders only)

Cardholders Name: Start Date: I Authorise You To Collect The Amount Of: Product Code (Office use only) Expiry Date: 371.00 REGTA13

Issue No:

Cardholders Signature:

Date:

IMPORTANT: Payment by Company or Personal Cheque

1. All cheques should be made payable to the Institution of Civil Engineers. Please include with this form. 2. If sending in multiple applications please indicate each trainees membership number on the reverse of the Cheque. Please Note: If you are making an application for Graduate Membership at the same time you can apply online at: ice.org.uk/ta. If however you choose to submit a Graduate Application form with the Training Agreement Application form, please ensure you have also included an attested proof of qualifications and graduate fee (ice.org.uk/fees). Please return to: CATS Co-ordinator, Initial Professional Development, Institution of Civil Engineers, One Great George Street, London, Westminster, SW1P 3AA, UK T: 020 7665 2200 F: 020 7233 0515 E: cats@ice.org.uk W: www.ice.org.uk

Initial Professional Development ICE3142

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Version 3 Revision 10 30 October 2012 Registered Charity 210252 & Scotland SC038629