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Chartered Institute of Management and Leadership

ware, Uni
Dela
Delaw
Unitted States of Ameri
Americca

RSHIP APPLIC
ATION FORM
MEMBE
MEMBER
APPLICA
Please indicate which membership level you are applying for:
Graduate (Grad.CIML)

Associate (ACIML)

Full Member (MCIML)

Fellow(FCIML)

State/country where applied from........................................

Name of Student........................................................
Date of Birth.. Sex Marital Status............
ADDR
ADDREESS
SSEES
Permanent home address:
...............................
Address for Correspondence (if different from home address)..
.............
Postal Code:............ Tel:................................................... Fax:............
Email:................................................................................................................
(Particula
articularrs of Educ
ducaation)
School, College or other Secondary
Institutions Attended

Date
Qualification/Certificate Obtained
From

To

The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code, Title 6; Chapter 18 of the state of Delaware
statues in the United States of America

University, Polytechnic, College or

other
Higher Institutions Attended

Course of Study

Degree, Diploma,
Professional
Qualification Obtained

Date of Award

nt hi
(Emplo
(Employyme
men
hisstory)

Current Occupation

Employer

Position Held - Title

Duties in Brief

Period of Service

Finding out about CIML:

rs
How did you fi
firs
rstt learn about CIM
CIMLL, USA?
All applicants should note that the Institute reserves the right to make without notice changes in
regulations, courses, fees etc at any time before or after a candidate's admission. Admission to the Institute
is subject to the requirement that the candidate will comply with the Institute's registration procedure and
will duly observe the Charter, Statues, Ordinances and Regulations from time to time in force. Programme &
Application fees once paid are not refundable.
Decla
Declarration from Appli
Appliccant
I am willing to apply for Membership of Chartered Institute of Management and Leadership, USA and for the
same I am submitting this form through the authentic study center of the Institute.
All the information provided above in the form are true to the best of my knowledge.
I have confirmed the affiliation status of the study center through the official website of the
Institute(www.cimlglobal.us), the name and link of the study center is present in the list of Global Affiliates of
the institute.

The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code, Title 6; Chapter
18 of the state of Delaware statues in the United States of America

CIML, USA maintains its global accreditations, affiliations, and recognition as per its management decisions
and is not focusing on any country specific accreditation/recognition. I, the applicant, would be solely
responsible for acceptability of the earned certificate in the region of use.
I would abide by the rules and regulations of the Institute failure in which the institute may take disciplinary,
legal, or formal actions as the case may be. Decision of the Management of the institute would stay final in all
cases.

Signature of Applicant: Date: . Place: ..

Decla
at
or
Declarration from Nomin
Nominat
ator
As on date, I am an authentic affiliate/nominator of the Institute and the status of my affiliation with CIML,
USA is available on its official website of the Institute (www.cimlglobal.us). The same has been shared with
the applicant.
I have confirmed the identity and eligibility of the applicant. All the information provided above in the form is
true to the best of my knowledge.
I am nominating the applicant for aforesaid Membership grade of Chartered Institute of Management and
Leadership, USA and for the same I am submitting and signing this with the applicant.
I have seen all original documents and have put the attested photocopies of all documents in my records.
I would maintain the application records, study records, and performance record of the candidate in my safe
repository and will provide to the Institute if demanded anytime in future (up to 10 years).

Signature and Stamp of Nominator: Date: .

nts to be at
Docume
Documen
atttached with this form:
1.
2.
3.
4.
5.
6.

Two passport size photographs

Attested photocopies of all educational certificates (10th onwards)
Address Proof (Electricity Bill/Mobile Bill/Driving License/Credit Card Statement in the name of candidate only)
Identity proofs (some document issued from State/Central Government only, like Passport/Driving License etc.)
A detailed resume of the candidate
Attested photocopies of work experience certificates

The Chartered Institute of Management and Leadership is incorporated and chartered under Delaware Code, Title 6; Chapter
18 of the state of Delaware statues in the United States of America