Academic Assessment

Application ASSOCIATION OF PROFESSIONAL

ENGINEERS & GEOSCIENTISTS
OF MANITOBA
Internationally Educated My Life’s Work
Makes Life Work Better

1) Personal Information
a. Name

Dr. Mr. ■ Mrs. Ms. Miss

Last Name: JAVIER

Given Name(s) (underline the name commonly used):

CHERRY

b. Name Change

Your current name, if different from above:

c. Birth Details
Male ■ Female

Birthdate (MONTH / DATE / YEAR): JANUARY 11, 1977

Country of Birth: PHILIPPINES

d. Current Address

Street: 2 CLOVERMEAD ROAD

City: WINNIPEG

Province:
MANITOBA Country:
CANADA Postal Code: R2R 1K5

Telephone: Mobile:
204 890 2530 204 930 9093

Fax: Email: cherrysyjavier@yahoo.com

2) Citizenship/Immigration Status
You can start the assessment process regardless of immigration status and physical location; however, exams
must be written at APEGM. Membership with APEGM requires one year of work experience in Canada so,
eventually, you will need to obtain citizen/immigration status to work here legally.

Your citizenship/immigration status in Canada:

Canadian Citizen ■ Permanent Resident Work Permit

Study Permit Refugee Other

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 1 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

3) Employer Information
If you are currently unemployed please leave this section blank.

a) Current employer/company name: MOTOR COACH INDUSTRIES

b) Work Email address: Cherry.Javier@mcicoach.com

4) Professional Status
Answer yes if you applied recently or in the past, even if you withdrew.

a) Have you ever applied to APEGM?

Yes ■ No

If yes, what year did you apply?

b) Have you ever applied to any other Engineering or Geoscience association in Canada?

Yes ■
No

If yes, please name all associations:

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 2 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

5) Discipline
a. Please check one:
■ Internationally Educated Engineer

Internationally Educated Geoscientist

b. An academic discipline or field of study is a branch of knowledge that is taught and researched as part
of higher education.
Indicate the discipline that you wish to be examined in . If your discipline is not listed below, please choose one
that closely matches. http://www.engineerscanada.ca/examination-syllabus

If your discipline is not an exact match with the options below, choose up to two that match closest.

Engineering Discipline:

Agricultural / Biosystems / Engineering Physics Mining and Mineral Processing

Bioresource / Food Engineering
Biomedical/Biochemical
Engineering
Building Engineering
Chemical Engineering
Civil Engineering
Computer Engineering
✔
Electrical Engineering
Environmental Engineering Engineering
Forest Engineering Naval Architectural Engineering
Petroleum Engineering
Geological Engineering
Software Engineering
Geomatics Engineering
Structural Engineering
Industrial Engineering
Other :
Marine Engineering
Mechanical Engineering
Metallurgical Engineering

Geoscience Discipline:

Geology Other :

Geophysics

c. If your discipline of your undergraduate degree is NOT the same as the discipline you’ve been
practising please provide details.

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 3 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

6) Education
List your education in chronological order, do not abbreviate, and be sure to provide all requested detail.
NOTE To be eligible for an assessment, you must have completed a four-year minimum, post-secondary
program (typically Bachelor’s degree) in a field related to Engineering or Geosciences.

Full Name of Institution: POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Full Name of Degree or Diploma: BACHELOR OF SCIENCE IN ELECTRONICS AND COMM. ENGINEERING

Discipline Study:

City of Institution: STO. TOMAS EXTENSION, STO. TOMAS, BATANGAS

Country of Institution: PHILIPPINES

Date Degree Awarded: 2001

Degree / Diploma duration ■ 5 Year 4 Year 3 Year
I attended from: 1996 to: 2001
Was any part of your education completed by: correspondence / online / distance education? Yes ■ No
If yes, please give details:

Additional Degree/Diploma
NOTE If you do not hold any additional Degree(s)
or Diploma(s), please go to Section 7.

Full Name of Institution:

Full Name of Degree or Diploma:

Discipline Study:

City of Institution:

Country of Institution:

Date Degree Awarded:

Degree / Diploma duration 5 Year 4 Year 3 Year
I attended from: to:
Was any part of your education completed by: correspondence / online / distance education? Yes No
If yes, please give details:

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 4 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

Additional Degree/Diploma
NOTE If you do not hold any additional Degree(s)
or Diploma(s), please go to Section 7.

Full Name of Institution:

Full Name of Degree or Diploma:

Discipline Study:

City of Institution:

Country of Institution:

Date Degree Awarded:

Degree / Diploma duration 5 Year 4 Year 3 Year
I attended from: to:
Was any part of your education completed by: correspondence / online / distance education? Yes No
If yes, please give details:

Additional Degree/Diploma
NOTE If you do not hold any additional Degree(s)
or Diploma(s), please go to Section 7.

Full Name of Institution:

Full Name of Degree or Diploma:

Discipline Study:

City of Institution:

Country of Institution:

Date Degree Awarded:

Degree / Diploma duration 5 Year 4 Year 3 Year
I attended from: to:
Was any part of your education completed by: correspondence / online / distance education? Yes No
If yes, please give details:

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 5 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

7) Declaration of Consent
I authorize APEGM to retain all information contained herein and any appended documents including transcripts,
work history, proof of degrees, syllabi, translations of same, and any and all information for the purposes of
assessing my academic qualifications. I also authorize APEGM to make any enquiries of any institutions to
which I may have applied, in order to assess my academic or other qualifications as related to my professional
registration.

I understand that this information will be kept on file in accordance with APEGM’s retention policy. After
completion of the assessment of my academic qualifications, or after I complete the academic assessment
program or withdraw from the program, I wish to have the following actions completed:

a. Choose one only:

■ Return by mail all original and / or notarized documentation provided by me including transcripts, syllabi, and
proof of degrees. I understand that APEGM will be sending this documentation by regular mail and is not
responsible for any loss incurred once the documentation leaves its office.

I will pick up the original or notarized documentation. When picking up your documentation you will be asked
to sign for the documents or provide picture ID for proof of identification. Documents will only be kept for a
3-month period. It is your responsibility to pick up your documents.

I declare that all of the information provided is authentic and correct to the best of my knowledge and belief. I
understand that a false statement or failure to provide the information requested may, at any time, disqualify
me from the assessment program. I authorize APEGM to obtain such additional information as it may deem
appropriate, from such additional sources as it may deem appropriate, for the processing of my application.

I understand that it is my responsibility to update my contact information with APEGM as required. If I fail to
do so, APEGM will not be held responsible for any consequences related to inaccurate contact information
including missed mailings, failure to receive renewal forms or routing of personal information to other persons not
authorized to view such information.

I understand that if I request my personal information to be given to me over the phone or by email, APEGM
is required to make reasonable efforts to confirm my identity. In order to do this, APEGM will ask one or more
authentication questions.

b. I authorize APEGM to release details of my file to my employer(s) or potential employer(s).

■ Yes No

c. I authorize APEGM to release details of my file to the University of Manitoba.

■ Yes No

Signature of applicant: Date:

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 6 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

8) Application Fee
Please see apegm.mb.ca for application fees.

Type of Payment:
■ I am enclosing a money order/cheque payable to APEGM

I wish to pay by credit card:

Visa MasterCard American Express

Amount: $

Credit Card Number:

Expiry Date: Validation Number*:

*The validation number is a three-digit number on the back of your credit card, beside your signature.

Signature of Card Holder:

9) Required Documents
Submit the following documents with your application. If you fail to provide the required documents,
APEGM will return your application.
Language Requirements
All required documents listed below must be provided in English. If your documents are not in English,
you must provide notarized English translations. See Language Requirements at apegm.mb.ca
Checklist
Check each box once you add the required document to your application package.
✔ Legal change of name document (if applicable)
If your name is different from the name in your documents, attach a legal change of name document such as
a Marriage Certificate, Certified record of divorce, or a valid, unexpired, passport issued in your current name.
✔
Original OR notarized degree, diploma, or certificate (for each degree/diploma that you hold)
✔
Photocopy of each of the above
✔
Notarized Transcript (for each educational program)
✔ Photocopy of each of the above
Syllabi (if available)
You may submit an application without a syllabus (course description); however, APEGM may request it at a
later date.
A course description is a brief paragraph that clearly describes course material. Please map the course
numbers and titles in your transcript with the course numbers and titles found in the syllabus - provide a list
indicating the page number in the syllabus where each course description can be found.
Engineering or Geosciences report (if available)
An Engineering or Geosciences report (sometimes referred to as a thesis or project report) is not required at
the time of application but APEGM may ask you to submit it at a later date. You may submit the report in the
original language; however, you must also provide the report title, outline, and an extended abstract (i.e., 4–5
pages) in English.

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 7 of 8
 870 Pembina Highway T: 204.474.2736 apegm@apegm.mb.ca
Winnipeg, MB TF: 1.866.227.9600 apegm.mb.ca
Canada R3M 2M7 F: 204.474.5960

✔ English Language Test Results

If English is not your first language or you did not receive your undergraduate or graduate degree in English,
please provide a copy of the results of an English language proficiency test such as the Canadian Level
Benchmark (CLB) test or International English Language Testing System (IELTS).
See Language Requirements at apegm.mb.ca
✔ Detailed Chronological Resume
✔ Photocopy of one of the following:
• Drivers Licence
• Permanent Resident Card
• Current Passport
Photocopy of any other related information you wish to provide
✔

Other related documentation might include:

• A list of published papers relating to Engineering or Geoscience
• Proof that you are licensed in another province or country
• Proof that you have passed the NCEES Fundamentals of Engineering and/or the
NECEES Professional Engineering exam (USA)
Official transcripts
Please ask your academic institute to send your transcript(s) directly to APEGM to the
attention of the Assessment Officer. All transcripts MUST be mailed to APEGM directly
from your institution in a sealed envelope. Student-issued transcripts are not acceptable.
If you hold an Engineering undergraduate (Bachelor-level) degree from a foreign country and a Post-Graduate
degree from a (Canadian) CEAB-accredited program—or a Washington Accord Country—you may arrange
to have your post-graduate transcript sent to APEGM directly instead of the undergraduate (Bachelor-level)
transcript.
Date transcript ordered:

10) Delivery
Deliver your required documents, this entire application form, and your fees by mail/courier or in person.
Mail to:
Assessment Officer
APEGM
870 Pembina Highway
Winnipeg, MB, Canada
R3M 2M7
OR
In person:
Contact the Assessment Officer to arrange a meeting to submit your application:
cshymko@apegm.mb.ca

At the meeting, your package will be reviewed and questions can be addressed.
Please allow one hour for the meeting.

OFFICE USE ONLY Member # ______________ Academic Assessment Application - Internationally Educated Page 8 of 8