Certified Director

Renewal Application Form 2017

The Institute of Directors in Southern Africa (IoDSA)

BACKGROUND

The Accelerated Directorship Programme (ADP) was offered by the IoDSA from 2009 to 2012. Delegates who were members of the IoDSA, who attended all required training sessions and who completed the ADP assessments successfully, received an IoDSA Certificate in Directorship, held the designation of IoDSA Certified Director and were entitled to use the IoDSA post-nominal Cert. Dir.

Due to requests from IoDSA members, the IoDSA will re-launch the Certified Director as a professional designation on Friday, 10 March 2017. This document is to be completed by individuals who held this designation in the past and would like to retain their status following its re-launch.

Individuals wanting to retain their Cert. Dir. status have until Friday, 24 February 2017 at 16:00 to complete this form and submit it to the IoDSA.

BENEFITS

This retention process is being offered free of charge to individuals who successfully completed the ADP in the past.

Individuals who choose not to retain this designation now will need to enroll for and successfully complete the full new process that will be launched on Friday, 10 March 2017.

REQUIREMENTS

Individuals wanting to participate in this renewal process need to be a paid-up, full members of the IoDSA.

The applicants need to:

  • Complete this Renewal Application Form
  • Attach a certified copy of their ID document
  • Attach a copy of their ADP Certificate

SECTIONS OF THIS FORM

There are 5 sections to this form. Each section must be completed in full.

The completed form can be emailed to Director Certification at . Or a hard copy of the documents can be delivered to the IoDSA offices at:

Director Certification (c/o Dr M Serfontein)

IoDSA

144 Katherine Street

First Floor, Grayston Ridge Office Park

Sandown, Sandton

  1. PERSONAL DETAILS (compulsory)

A.1. For IoDSA use

Titles (Mr./ Mrs./Ms./Other) / Name of Company (where applicable)
Surname
First Names / VAT No. (of company, where applicable)
Known as / Home Address
Date of Birth
Nationality / Code
ID No.
Alternative ID No. / Postal Address
Alternative ID Type
IoDSA Membership No. / Code
Male / Province
Female
African
Indian / Asian / Phone No.
Coloured / Fax No.
White / Cell No.
Other / Email

A.2 For SAQA reporting

Residential Status / South African / Socio-Economic Status / Employed
Other / Unemployed
Dual:
Permanent Resident / Disability Status / None
Other / Sight
Hearing
Home Language / English / Communication
Afrikaans / Physical
siSwati / Intellectual
TshiVenda / Emotional
seSotho / Multiple disabilities
isiXhosa / Unspecified
sePedi / Other
xiTsonga
isiNdebele / Highest School Qualification / Grade 12 / Matric
seTswana / Other
isiZulu / Highest Qualification Achieved
Other
Qualification(s) currently enrolled for
  1. CODE OF CONDUCT

Read through the Code of Conduct for Chartered Director (SA) and Certified Director.

By my signature hereto, I declare my commitment to uphold the principles and standards of conduct outline in this Code for Conduct for Chartered Director (SA) and Certified Director. I understand that should I not adhere to the standards set out herein, I may face review and sanction by the IoDSA.

Signature / Date
  1. CONTINUING PROFESSIONAL DEVELOPMENT (CPD)

The Certified Director (Cert.Dir.) being launched on Friday, 10 March 2017 is slightly different from the programme completed by delegates during the period 2009 and 2012 to gain the Certified Director.

To this end, the IoDSA requires that individuals renewing their status must ensure that within 1 year (by 9 March 2018), they have:

  • Participated in the one day IoDSA King IV training or equivalent and thereby earned a compulsory 5 CPD hours; and
  • Submitted a CPD record card detailing how they have completed an additional 15 CPD hours within the 1 year period.
  • The 15 CPD hours need to be gained through participation in at least 3 of the following categories:
  • Professional work-based activities
  • New director mentoring
  • Personal activities outside work
  • Courses, seminars and conferences
  • Self-directed learning activities
  • 1 CPD hour equates 1 hour of content bearing activity
  • The CPD activity must be aligned to the Director Competency Framework

More detail about the CPD can be found on the website at

Signature / Date
  1. CANDIDATE DECLARATION

I ______the designee and applicant:

  • declare that the statements on this form and other information provided by me in support of my Cert.Dir. application are correct and true to the best of my knowledge and belief;
  • hereby give the IoDSA authority to verify and check any of the information given on this form or otherwise provided and in doing so I agree that the IoDSA may make such enquiries as it deems fit to validate its assessment of my information submitted;
  • agree to submit any further information which may be called for by the IoDSA in support of my Cert.Dir. application;
  • agree to be bound by and to comply with the IoDSA Cert.Dir. requirements in terms of gaining Cert.Dir. status, as amended from time to time;
  • agree and accept that certain requirements contained in the IoDSA Cert.Dir. requirements, as amended from time to time, affect me directly as a designee and I undertake to be bound by and to comply with all such requirements whilst I am a designee;
  • hereby give my authority to the IoDSA to disclose any of the foregoing particulars as the IoDSA may, in its absolute discretion, think fit in relation to my becoming a Cert.Dir.
  • Agree that the information on this form can be entered onto the IoDSA database. Information about members is kept strictly confidential, in accordance with existing data protection legislation;
  • Undertake and warrant that I have not been declared insolvent, been sequestrated, that I have no criminal record or outstanding criminal charges still under prosecution; or any other finally determined or pending legal proceedings against my name, both locally or internationally.

I ______, agree that I will be an active participant in this process of becoming a Cert.Dir., in doing so I agree to

- Permit my successful application to be publicised by the IoDSA;

- Permit my becoming a Cert.Dir. to be publicised by the IoDSA; and

- Any other reasonable requests made by the IoDSA.

Signature / Date
  1. FINAL CHECKLIST

Please ensure that this form is complete and that the following documents have been attached to your submission (tick each box below):

Completed application form signed by the applicant (section D)
Certified copy of ID (certified within the past 3 months)

Statement from the IoDSA:

The IoDSA may, at its discretion, refuse to accept any application which may place the IoDSA or the profession at risk or withdraw the designation from any Certified Director who breaches the Code of Conduct and/or the undertakings given to the IoDSA as member.