Academic Associate (Academic Assoc CIPD)
Academic Member (Academic MCIPD)
Academic Fellow (Academic FCIPD)
Please tick the box of the level of membership you are applying for:
Academic Membership Assessment
Membership of the CIPD
Academic Application form
Your Institution:
You can return this application form (attaching copies of your up-to-date CV,
job description and highest qualification certificate) by either email or post.
Please submit this interactive form and supporting documents as soon as
possible.
Email: Scan any hard copy supporting documents and email to
AcademicAssessment@cipd.co.uk
Post:
Academic Administration
Chartered Institute of Personnel and Development
151 The Broadway
London
SW19 1JQ
If you have any questions, please email AcademicAssessment@cipd.co.uk or
call +44(0)20 8612 6238.
D D M M Y Y
Please read these notes before completing the form
To help us process your application promptly, please write clearly and use block capitals throughout, following any instructions
carefully. If your form is not completed correctly, this may delay your application.
Home details
Address ..............................................................................................................
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Town ......................................................Postcode............................................
County ................................................................................................................
Country ..............................................................................................................
Email ...................................................................................................................
Tel ........................................................................................................................
Work details
Job title ..............................................................................................................
Organisation .....................................................................................................
Address ...............................................................................................................
...............................................................................................................................
Town ....................................................Postcode..............................................
County ................................................................................................................
Country ..............................................................................................................
Email ...................................................................................................................
Tel ........................................................................................................................
Existing Members Membership number
(if applicable): .......................................................................................... Grade ........................................................
Title.....................................................................................................................
First name ..................................................................................................................Last name ........................................................................................................
The name you supply will be used on any certificates and correspondence sent by us, so please state the name you’d prefer us to use.
Date of birth
/
/
If you’re working in a ‘politically sensitive’ area (such as the armed forces, central government, police), please supply either a home or business address. Otherwise, please
supply both.
Section 1 – Your contact details
Mobile .................................................................................................................
By providing your mobile number, you are giving us permission to use it from time to time in order to contact you for the purposes of informing you
about your membership by SMS. However, we will not use it for direct marketing campaigns.
Twitter handle ..................................................................................................
Data Protection
The CIPD takes your privacy seriously and will keep your personal information private and secure. We’ll use your data to manage your member account
and contact you about member benefits and services. For more information, please view our privacy policy by visiting cipd.co.uk/privacy-policy
You can manage your marketing preferences by visiting our marketing preference centre at cipd.co.uk/myprofile/communicationpreference
LinkedIn profile ...............................................................................................
My preferred daytime telephone number is:
Home
Work Mobile
Please send my People Management magazine, membership and branch correspondence including emails to my:
Home address
Work address
You’ll be allocated automatically to a CIPD branch nearest to the postcode of your preferred mailing address.
I agree to abide by the CIPD’s Code of Professional Conduct available at cipd.co.uk/codeofconduct
I also give permission for you to contact the relevant persons or organisations to verify the information in my application, if appropriate.
By submitting this form you confirm that you accept our terms and conditions which can be found by
visiting cipd.co.uk/memberterms or call +44 (0)20 8612 6208.
Signature ................................................................................................................................................................Date .......................................................................
Your application will be delayed if we don’t receive all the required information. Please also ensure you complete Section 3, otherwise we
can’t process your application.
Section 2
Main focus of your job role: Lecturing Research
Other:
If you ticked both, please
enter the percentage of
time spent on each area:
Lecturing
Research
Current job title: .............................................................................................................
Length of time
in the role (years): ...................................
Please indicate the highest level you have reached in your academic education:
Degree Master’s degree Doctorate
Postgraduate Qualification MBA
Please state
the year this
qualification
was completed: ........................................
%
%
click to sign
signature
click to edit
You will need to be in CIPD membership (having paid a one-o joining fee and a membership fee). In order to be assessed
you will also need to pay a non-refundable assessment fee. Please refer to the Academic Assessment web pages here for
further details of the Academic Assessment fees.
When your membership comes up for renewal, payments will be collected each year on 1 July until you advise us
otherwise. We’ll send you a membership renewal pack at the start of June each year to remind you how much is due.
Notes
This form is for applying for Academic membership of the CIPD only.
1 Your membership fee is renewable annually on 1 July.
2 Some benefits and services may not be available to members outside of the UK and Ireland. At its absolute discretion, CIPD may at any time alter,
amend, change, modify or withdraw any of the membership benefits that comprise the membership oering.
3 The assessment fee must be paid before the assessment can take place. Your assessment cannot proceed without it. The assessment fee covers the
cost of your application being assessed, which includes the Peer Review discussion, membership decision and developmental feedback report. The
fee is non-refundable irrespective of the result of your assessment.
4 All amounts are shown in pounds sterling. If you prefer, you can make a payment in Euros. Please visit our website for the current exchange rate. If
you pay by credit/debit card, your card provider will use their own exchange rate.
Assessment Decision
Your application is assessed by our Academic Assessors based on the evidence you and your colleagues provide. CIPD do not undertake
any preliminary assessment of your evidence before your appointment.
Cancellation
The Assessment fee cannot be refunded if you are unable to proceed with the assessment. If you are unable to proceed with your
Peer Review discussion and have notified the CIPD no less than two weeks before it is due to take place, the CIPD will endeavour to
arrange another Peer Review discussion for you. After this date a new application and fee may be required to complete an assessment
application.
Section 3 – Membership fees
Please indicate your preferred payment method
If you would like to pay for Academic Assessment by credit/debit card, please give us the best telephone number to
contact you on and we will call you to take your payment.
Telephone .........................................................................................
Please find enclosed a cheque for £............................. (Payable to CIPD)
Please invoice my organisation:
For the attention of: ....................................................................................
Invoice address
(if dierent to your work address)
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
For oce use only: Membership number
If you have any question about the event or Academic membership, please email: AcademicAssesment@cipd.co.uk
Chartered Institute of Personnel and Development
151 The Broadway London SW19 1JQ United Kingdom
T +44 (0)20 8612 6200 F +44 (0)20 8612 6201
E cipd@cipd.co.uk W cipd.co.uk
Incorporated by Royal Charter
Registered as a charity in England and Wales (1079797)
Scotland (SC045154) and Ireland (20100827)
Issued: May 2019 Reference: 7201ACAD
© CIPD 2019
Purchase order (if applicable)................................................
If you’re using a company cheque to pay your fees,
please ensure that your name is clearly stated on
the back.