Application Form for Chartered Scientist

Please read the ‘Guidance to applicants’ before completing this form. Please submit the form, together with a cheque for £25 made payable to ‘The Society of Chiropodists and Podiatrists’, to the Postgraduate Education Officer, The College of Podiatry, Second Floor, Quartz House, 207 Providence Square, Mill Street, London, SE1 2EW.

Surname / Forename(s)
Title / Date of birth
Membership No: / HCPC Registration No:
Home address / Employment address
Address / Job title
Address / Company
Address / Address 1
Town / Town
County / County
Postcode / Postcode
Telephone / Telephone
Email / Email
Professional Qualifications / Academic qualifications
Institution / Institution
Qualification / Qualification
Subject / Subject
Institution / Institution
Qualification / Qualification
Subject / Subject
Proposer
I, the undersigned, being a chartered scientist in good standing with the Science Council bear witness to the applicant having the required professional experience and qualifications. I have read their personal statement and confirm that the applicant is able to:
1. / Use a combination of general and experiential knowledge, understanding and skills to be able to optimise and engage in the application of existing and emerging science and technology.
2. / Use theoretical and practical methods in the analysis and solution of problems
3. / Communicate effectively
4. / Plan and organise projects effectively
5. / Work effectively in a team
6. / Use effective influencing and negotiating skills
7. / Continue to advance their knowledge, understanding and competence to a high level and demonstrate a commitment to CPD.
8. / Demonstrate an understanding and commitment to Health and Safety and environmental issues related to employment
9. / Comply with the relevant Codes of Conduct-
Signature: / Membership No:
Name: / Date:
Personal Statement from the Applicant
Provide evidence (c500 words for each category i.e. A1, A2, A3, B1, B2, B3 etc.) showing how you meet the nine aspects of professional practice.
A / Deal with complex scientific issues, both systematically and creatively, make sound judgements in the absence of complete data and communicate their conclusions clearly to specialist and non-specialist audiences.
A1 / Use a combination of general and experiential knowledge, understanding and skills to be able to optimise and engage in the application of existing and emerging science and technology.
A2 / Use theoretical and practical methods in the analysis and solution of problems.
A3 / Communicate effectively
B / Exercise self-direction and originality in solving problems, and exercise substantial personal autonomy in planning and implementing tasks at a professional level
B1 / Plan and organise projects effectively
B2 / Work effectively in a team
B3 / Use effective influencing and negotiating skills
C / Continue to advance their knowledge, understanding and competence to a high level and demonstrate a commitment to CPD. [Note: Registrants seeking re-validation will be required to satisfy the CPD Standards for Chartered Scientists].
D / Demonstrate an understanding and commitment to Health and Safety and environmental issues related to employment.
E / Comply with the relevant Codes of Conduct
Applicant’s Declaration
I certify that all information provided in this application is accurate and that I agree to my name being added to the Register of Chartered Scientists held by the Science Council should my application be successful.
Signature: / Membership No:
Name: / Date: