|
Certificate In Project Management
Application Form
Section 1
1.1 Name
Prefix:(Mr./Mrs./Ms./Dr.) First Name
Initial
Last Name
Date of Birth
Name for printing in certificate if different to above:
1.2 Home Address (If applying from outside India, kindly indicate your country*)
City:
State:
Country:*
Pin/Zip code
1.3 Email Personal:
Email Work:
1.4 Phone
Country Code
City Code
Mobile No
Work Landline:
Extension:
1.5 Number of hours of Project Management Training Undergone:
(Minimum of 20 hours of project management
training is required for certification) (rounded to integer)
1.6 Highest Qualification:
Expereince in Yrs:
1.7 Designation:
1.8 Your main industry:
1.9 Company Name & address (If applying from outside India, kindly indicate your country*)
City:
State:
Country:*
Pin/Zip code
1.10 Photo ID Type
Reference No.
(PAN / Aadhar / Driving License / Passport / Company issued Identity)
1.11 Self certified copy of the project management training program of 20 hours minimum.
(Not required as you have gone through module 1 of Totality of Project Management.)
1.12 Self certified copy of the Graduation certificate or any other higher degrees.
1.13 Special Needs (if any)
(For example, related to physical disability)
Section 2 DECLARATION
I
S/o, D/o/ W/O hereby declare that:
* I am aware about the CIPM Certification Process & examination format. I will comply with certification process
requirement & will supply any and all information needed for assessment purpose.
* I am a graduate in and have got valid degree from university/Institute of
* I will undergo 20 hours of formal training in Project Management in line with the CIPM
syllabus from (Name of
Institute)
* Scope of the Certificate In Project Management certification is known and fully clear to me along
within the certification
process, certification assessment methodology and certification prerequisites.
* I will maintain full confidentiality of the certification examination. I will not copy, share, distribute
or use any unethical
means in answering the examination paper.
* I will not copy the examination paper questions nor will I disclose the exam paper contents to any
person whatsoever.
* I will work towards the best interests of my organisation, society at large, public safety
and the environment.
* I will be fair in all my dealings and work with out any prejudice or bias with all stakeholders,
customers partners
irrespective of their status, gender, age, caste, religion.
* I will discharge my dues ethically with utmost integrity and keep stakeholders informed as
requires in performing my
dues.
* As a professional working directly or indirectly in projects, I agree to honour and abide by the Code
of Ethics and
Professional Conduct of International Institute of Projects and Program
Management as given to me. It is also available
on their website https://www.i2p2m.com/page/cipm_code_of_ethics.
* On earning the CIPM credential, I will comply to the Code of Ethics & Professional Conduct and if
there is any non
compliance to this Declaration, I will inform i2P2M without delay.
* In case my certification is suspended or withdrawn, I will not use certification credentials. i2P2M
will have rights to
publically display my changed status on i2P2M website.
Place:
Date: Signature:
|