Support for Fellowship application 2020

Statement of Support for Examiner application

This form is to be completed by a referee who has agreed to support an application to become an FPM Examiner
Applicants to become an FPM Examiner are required to provide a statement of support from a referee.
Your name*

TitleFirst nameLast name
Your email*
example@example.com
Your membership number (if known):
Name of applicant you are supporting*

TitleFirst nameLast name
About you (you must select all options)*

I have a relevant professional connection with the applicant (see Notes below)I am a Member (MFPM) / Fellow (FFPM) and/or a member of the Board of ExaminersI confirm I have reviewed the application submitted by the named applicant:
Signature

I confirm that to the best of my knowledge the information supplied by the applicant is true and accurate.
Signature of applicant (use the cursor to sign your name)*

Clear
Notes:

A referee must:
- Have a relevant professional connection with the applicant e.g. a current or former manager, co-worker, ES or SA
- Be medically qualified and a Member/Fellow of FPM and/or a Member of the Board of Examiners
Should be Empty:

Statement of Support for Examiner application