Section 1: Personal Details
Trainer Name:
Training Centre(s) Name:
Trainer’s Main Address:
Please attach a list of any satellite locations that that are included as part of the Centre Approval.
Trainer’s Telephone:
Trainer’s Email:
Trainer’s IEMA Membership Level and Membership Number:
Courses you are applying to register as a trainer (Titles)
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Section 2: Teaching/Training and Subject Knowledge
Qualifications (please provide copies of all relevant certificates with this form)
Please list all teaching/training and environmental/sustainability knowledge related qualifications and the date of achievement that you hold relevant to the course that you are applying for (please see course specifications for specific trainer requirements).
Teaching/Training Qualifications and Date: / Environmental/Sustainability Knowledge Qualifications and Date:
Continuing Professional Development
Please provide details of how you keep up to date with teaching/training and relevant environmental/sustainability knowledge including all CPD (Continuing Professional Development) undertaken in the last 12 months.
Teaching/Training CPD: / Environmental/Sustainability Knowledge CPD:
Section 3: Experience
Previous and Current Employment
Please detail current and previous employment along with the main responsibilities held, ensuring that you also cover relevant information linked with the course trainer requirements that you are applying for. Please start from the most recent employment.
Job Title:
Dates of Employment:
Employers Name & Address:
Main Responsibilities:
Job Title:
Dates of Employment:
Employers Name & Address:
Main Responsibilities:
Job Title:
Dates of Employment:
Employers Name & Address:
Main Responsibilities:
Job Title:
Dates of Employment:
Employers Name & Address:
Main Responsibilities:
Practical Experience & Skills
Please submit a statement, providing specific evidence of practical experience and skills (including figures, company names and dates where possible) in training/teaching and environment/sustainability relevant to the course that you are applying for (please see course specifications for specific trainer requirements). Please write no more than 250 words for each section (bullet points are accepted).
Teaching/Training Experience (including experience in writing course materials and programmes):
Environmental/Sustainability Experience:
Section 4: Other Information
Use this section to provide any other information you feel is relevant to your application.
Section 5: Declaration & Signature
The information given in support of this application is true and accurate to the best of my knowledge.
Applicant Signature: (Electronic Signature accepted)
Printed Name:
Date:
Please send your completed application form as a Microsoft Word document along with all other application information in electronic format via email or USB/CD to:
IEMA Training, City Office Park, Tritton Road, Lincoln, LN6 7AS, UK
Email:
Section 6: IEMA Training Assessment (IEMA to complete this section)
Assessor Name:Date of Assessment:
Does the Applicant have a teaching qualification?
Does the Applicant meet the teaching/training experience requirements for the course?
Does the Applicant meet the subject knowledge requirements for the course?
Does the Applicant meet the IEMA membership requirements for the course?
Is the Applicant already approved as a trainer for any other IEMA courses?
Any other relevant information:
Is further information required?
Approval granted (Yes/No)? If No state the reasons
Registered Trainer Application Form Version 2.1 June 2016 1