04177 CFSA BROCHURE.qxd - TÄ°DE

Character Reference FormNote to Recommender:The individual named below has applied to sit for the Certified Financial Services Auditor (CFSA) examination.In considering the candidate’s qualifications for the CFSA designation, we require a character referenceevaluation by a CFSA, an individual with another IIA certification, or the candidate’s supervisor. The basis forthis evaluation is the Code of Ethics established by The IIA. Please read the Code of Ethics and then completethis form. The Code of Ethics is available on p. 19 of the CFSA Program Information and Registration Packageor by visiting “Guidance” at www.theiia.org.Please return this form to the candidate so that the form may accompany the candidate’s CFSA ExamApplication Form.Information About Candidate:Candidate’s Name (please print):______________________________________________________________________________________(Last Name) (First Name) (Middle Initial)Candidate’s Organization:________________________________________________________________Recommender’s Authority:I am (check all that apply):■ A CIA (Certified Internal Auditor)■ A CFSA (Certified Financial Services Auditor)■ A CCSA (Certification in Control Self-Assessment)■ A CGAP (Certified Government Auditing Professional)■ The candidate’s supervisor (current or prior)Statement of Character Reference:In my opinion, (candidate’s name) __________________________________________________________meets the qualifications set forth by the Code of Ethics established by The Institute of Internal Auditors.Recommender’s Signature: ________________________________________________________________Date: __________________________________________________________________________________Information About Recommender:Name (please print):______________________________________________________________________Title/Position: __________________________________________________________________________Organization:__________________________________________________________________________Address:______________________________________________________________________________Business Phone: ________________________________________________________________________Fax: __________________________________________________________________________________E-mail: ________________________________________________________________________________17 Register Today! Online: Visit “Certification” at www.theiia.org