Student Member Application v.2

INSTITUTE FOR INTERNAL CONTROLS
Student Member Application

Student membership is open to full-time students not working in any professional position. A full-time student is defined as an undergraduate student enrolled in 9 semester hours (or equivalent), or graduate student enrolled in 6 semester hours (or equivalent) in an accredited college or university.

NOTE: STUDENT MEMBERSHIP IS LIMITED TO SCHOOLS WHO HAVE AN OPERATIONAL STUDENT CHAPTER ON CAMPUS.

For your convenience, Autofill will keep all your input data for 24 hours if you must leave the form before completing. You must use the same browser in order to pick up the form where you left off!
Annual Student Member Fee---$50.00

Please complete all required information below

Personal Information
Date

MonthDayYear
Salutation*
First Name*
Middle Name
Last Name*
Permanent Address*

Street Address

P.O.Box (if any)

CityState / Province

Postal/ZipCode (If you are applying from a country that does not utilize postal codes or zip codes, Type “N/A” or NONE. This field is not for PO Boxes)Country
Primary Phone Number*

Country CodeArea CodePhone Number
Mailing Address (if different from Permanent Address)

Street Address

P.O Box (if any)

CityState / Province

Postal/ZipCode (If you are applying from a country that does not utilize postal codes or zip codes, Type “N/A” or NONE. This field is not for PO Boxes)Country
Secondary Phone Number

Country CodeArea CodePhone Number
Personal E-mail*
University E-mail*
Academic Institution*
Degree Program in which enrolled*
Academic Status*
Anticipated Graduation (MM-YYYY)*
YesNo
If Yes, explain below:

0/100

Applicant's Declaration

Check the boxes below to affirm each statement:
*I Affirm that I am a full-time undergraduate or Graduate student as defined at the top of the application.*I agree to provide any supporting documentation requested by the nominations committee.*If accepted, I agree to abide by the IIC's Code of Ethics and the IIC Code of Professional Standards*I understand that I must renew my membership annually and be a member in good standing*I understand that Student Membership does NOT allow me to hold myself out as a CICA or CCS.*I declare that all of the information contained in this application is true and correct.

Applicant's Electronic Signature

WARNING: UNSIGNED APPLICATIONS WILL BE REJECTED!
Type your name in the box below, followed by /es/ to represent your signature*
NOTE: You MUST click the PRINT button on the “Submit and Pay” tab to provide a hardcopy of this form. You must do this before clicking the SUBMIT button since you may not be able to print out a copy of the form for your records once you click the SUBMIT button.

Credit CardCheck or Money Order to be sent by applicantCheck or Money Order to be sent by applicant's employerPayment Made directly to IIC country representatives (Pakistan, Greece, Philippines ONLY)
If paying by Check or Money Order, Click Submit Application below to send your completed application to the IIC. Send your Check or Money Order in the amount of $50.00 to:

Institute for Internal Controls Inc.

Attn: Membership Department

109 Mullen Drive

Sicklerville, NJ 08081

USA

NOTE: NO application will be considered before the receipt of full payment.
If you chose to pay your membership fees via 2Checkout, you must email membership@theiic.org for a link that will take you to the product page on 2Checkout where you can pay the required fees. No action on your application will be considered before receipt of payment in full.
Should be Empty:

INSTITUTE FOR INTERNAL CONTROLS

Annual Student Member Fee---$50.00

Please complete all required information below

Applicant's Electronic Signature

WARNING: UNSIGNED APPLICATIONS WILL BE REJECTED!