EET/AMIE/FO/04 - The Institution of Engineers Sri Lanka

EET/AMIE/FO/04
THE INSTITUTION OF ENGINEERS, SRI LANKA
120/15, Wijerama Mawatha Colombo 7.
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APPLICATION FOR EVALUATION OF DEGREES / QUALIFICATIONS FOR STUDENT/ ASSOCIATE
MEMBERSHIP OF THE INSTITUTION OF ENGINEERS, SRI LANKA
(Attach two set of photocopies of the documents. Please produce the original documents when submitting,
for reference and return)
1. Surname with initials (in block
letters)
Mr./Ms.
2. Names denoted by initials
3. Address – Residence (in
block letters)
4. Contact Nos.
5. Identity Card No.
6. Date of Birth
7. Employment details :
Designation
Organization
Address
Contact Nos.
E-mail address
8. * Indicate subjects passed at
G.C.E. (A/L) Examination with
gradings:
9.
Degree/ Qualification
Subject
Grade
i. ..........……….........................……... ........……...
ii. ....................………………............... ........……...
iii. ....................………………............... ........……...
iv. ....................………………............... ........……...
10.
11.
Field/ Discipline
University/ Institution
12. Address (University/
Institution)
13.
14.
* Entry qualifications by virtue
of which admission was
obtained
* Duration of Course
15. * Curriculum for each year of
course
16.
* Syllabi
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17. Detailed results
(i) For each year of Course
(ii.) Overall Results
I am submitting herewith the copies/originals of the under mentioned documents:
i. Prospectus of University YES/NO
ii. Curricula YES/NO
iii. Syllabi YES/NO
iv. Coursework Records YES/NO
v. Project Reports YES/NO
vi. Past question papers YES/NO
vii. Criteria for the Award of Pass/Class/ Honors YES/NO
I understand that the Institution may call me for a viva–voce examination to check my
educational standards. I will be prepared to face such an examination in the subject material
which I have learnt in the above mentioned course.
I am willing to pay the evaluation fee of Rs.5, 000/-. ( Five Thousand)
Date:
…………………………….……
Signature
For Office use only.
1. Name : …………………………………………………………………….
2. Amount Received : …………………………………………………………………….
3. Receipt Number : …………………………………………………………………….
4. Signature of Cashier : …………………………………………………………………….
5. Date : …………………………………………………………………….