THE UGANDA SOCIETY OF

PROFESSIONAL CHEMISTS
(USPC)
APPLICATION FOR MEMBERSHIP TO USPC

GUIDANCE NOTES FOR FILLING THIS APPLICATION FORM

Please read the information regarding USPC Membership Classes carefully before completing this application
form. The form must be filled in the applicant’s own handwriting.

Completing the Application Form

• The form must be completed in full

• Supplementary information, such as a Curriculum Vitae, to support your application is required. This
information should include details of your academic qualifications and cover the COMPLETE period
since obtaining your first degree or equivalent qualifications.

• All applicants for Member, Associate Fellow, and Fellow are required to provide the name of two
referees one of whom is normally a qualified Member of a recognised Professional Body. One of the
referees should normally have been immediately responsible for or be knowledgeable about the
applicant's recent professional activity

• We advise that you to send photocopies of any documents countersigned by one of your referees
rather than the originals

• If you are a non-member, you will need to pay your first year's subscription with your application

• If you are currently AMRSC, there is no charge associated with applying for MRSC

• Please attach the following to your completed form

o Evidence of your qualification(s) and course transcript(s) (where required)

o Appointment Letters for all the positions you have held (if applicable)

o List of published material (if relevant)

o Curriculum Vitae

o Recent Passport-size photograph

USPC Membership Application Form page 1 of 6

FULL NAME:
Attach recent
Passport-size
Date of Birth (dd/mm/yyyy):
photograph
here
Title: (Prof., Dr., Mr., Miss)

MEMBERSHIP CLASS

Class of membership required (Tick as appropriate):

Honorary
Student Member Student Member Companion Associate Member Fellow
Fellow
(Diploma or Bachelors) (Graduate and Post Graduate) Member Member

EDUCATION

First course (e.g. Bachelors, Diploma)

Name of Awarding Institution

Award (e.g. BSc, MSc)
Title of course (e.g. Chemistry)
Dates studied from: to: Date awarded:

Full/Part Time Classification (e.g. 1st, 2.1. 2.2, 3rd)

Second course (e.g. Bachelors, Masters)

Name of Awarding Institution

Award (e.g. BSc, MChem)
Title of Course (e.g. chemistry)
Dates studied from: to: Date awarded:
Full/Part Time: By exam, research or both:

Third course (e.g. Masters, PhD)

Name of Awarding Institution

Award (e.g. PhD)
Title of thesis
Dates studied from: to: Date awarded:

USPC Membership Application Form page 2 of 6

PROFESSIONAL EXPERIENCE:

A). Current (or most recent) role

Job Title
Dates: From:
Employer’s Name
Employer’s Address

Number of Staff directly indirectly

Supervised

Description of Duties

B) Previous role

Job Title
Dates From: To:
Employer’s Name

USPC Membership Application Form page 3 of 6

Employer’s Address

Number of Staff directly indirectly

Supervised

Description of Duties

c) Role prior to B

Job Title
Dates From: To:
Employer’s Name
Employer’s Address

Number of Staff directly indirectly

Supervised

Description of Duties

PUBLISHED MATERIAL (if applicable)

USPC Membership Application Form page 4 of 6

Please state the number of:

Books: Papers: Patents:

(Please attach your publications list indicating the “senior” author)

REFEREES: Give names and addresses of referees in the categories provided below.

Academic Referee

Name of Referee
Title:
Institution:

Postal Address:

Telephone Number:
Email:

Professional Referee

Name of Referee
Title:
Company:

Postal Address:

Telephone Number:
Email:

Supervisor (For Student Applicants ONLY)

Name of Referee
Title:
Institution:

Postal Address:

Telephone Number:
Email:

USPC Membership Application Form page 5 of 6

OTHER DETAILS
On a separate sheet of paper, please include any other information to support of your application. For
example, notable achievements within your organisation, external activity complimentary to job role,
conference activity, awards, membership of boards/committees or other Professional Organisations.

Declaration
I declare that while I am a member of Uganda Society of Professional Chemists, I will observe the regulations
of the Society and that I will conduct myself in a manner that befits the profession and to the utmost of my
power maintain the dignity and welfare of the Society.

Name of Applicant

Signature:

Date:

Please send this application to USPC by email or post. All supporting documentation must be attached.

The Secretary
Uganda Society of Professional Chemists
PO Box 30002
Kampala – Uganda
Email: membership@uspc.or.ug

USPC Membership Application Form page 6 of 6