Student Member Application

Student Member Application

Enrolled as Academic Partner of IPowerE
Student Details
Title*
Last/Family Name*
First/Given Name*
Middle Name (if any)
Correspondence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

DayMonthYear
Date
Telephone*

Area CodePhone Number
Mobile*

Area CodePhone Number
Personal Email Address*
example@example.com
College/University Email Address*
Chartered Engineer (CEng)Incorporated Engineer (IEng)Engineering Technician (EngTech)Other
If Other, please give details:
Are you a member of any other Professional Institutions? Is so please give details:(Institution, Grade, Membership Number)
Current Education Details
University/College Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone*

Area CodePhone Number
Course Being Undertaken*
Full timePart time
Start Date*

DayMonthYear
Date
Expected Completion Date*

DayMonthYear
Date
Previous Education Details
Secondary Education (Year, School, Exams Passed and Grade)
Higher Education (Year, College/University, Exams Passed and Grade)
Employment Details (if applicable)
Present Occupation (Brief description of role, responsibilities and experience including dates):
Employer (including Name, Address, Telephone Number and Job Title)
Previous Employers (Brief description of role, responsibilities and experience including dates):
Relevant Power Industry Experience:
How did you hear about IPowerE?
I wish to become a Student Member of the Institution of Power Engineers and agree that:

- I will observe the Rules of the Institution https://www.ipowere.org/IPowerE%20Rules.pdf

- I will observe the IPowerE Code of Conduct https://www.ipowere.org/codeofconduct.html
Signature

Clear
Referee Details

The referee is confirming that the information provided is accurate and true. Ideally they should be an existing IPowerE member, a member of another recognised professional body (if so please include membership number and Institution name) or a senior member of your university/college or employer.
Name of Referee*
Job Title
Correspondence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone*

Area CodePhone Number
Mobile*

Area CodePhone Number
Email Address*
example@example.com
Enter the message as it's shown*
Should be Empty:

Student Member Application

Enrolled as Academic Partner of IPowerE