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THE UGANDA INSTITUTION OF PROFESSIONAL ENGINEERS

APPLICATION FORM FOR MEMBERSHIP

Management Support Unit Building,

Public Works Training Centre,

Plot 2, Gloucester Avenue, Kyambogo
P.O. Box 1308, KAMPALA
Tel: 256-414-287292

Email: membership@uipe.co.ug/ Website: www.uipe.co.ug

Revised on……11th…………...Day of ………October……….…….2022

APPLICATION FORM FOR MEMBERSHIP OR TRANSFER TO CLASS OF
MEMBERSHIP

PLEASE FILL THIS FROM IN TYPE WITH CAPITAL LETTERS DO NOT HAND WRITE

1. GENERAL INFORMATION

Name in full: Surname: …………….………. Middle Name: …………………...First Name:

……………………….

Date of Birth (D/M/Y): ………………………………………………

Nationality: ………………………… Gender ……………………….

Academic Qualifications
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………
Engineering Discipline……………………………………….…………………

Place of work ……………………………………………………………………….

Current Job Title……………………………

City/Town name ……………………………………….

Street Name ……………………………………………...

Plot No. ………………………………………………….

Tel: +256………………... Email: ……………………………………………………...

UIPE Branch Membership: …………………………………...

Application route for Membership (please tick) (Applicable for Members)

£Projects £Academia £Mutual recognition (East Africa) £ Mutual Recognition

(Commonwealth) £ Temporary Registration

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Membership Class you are applying for (please tick only one):

£Technician £Technologist £Student £Graduate £Member £Fellow £Honorary

£Corporate (for companies only)

2. OBLIGATION AND CERTIFICATION

I, the undersigned, agree that in the event of my admission to the class of membership in the
Uganda Institution of Professional Engineers, I will be governed by the constitution and bye-
laws of the Institution, as they now are, or as they may hereafter be altered, and that I will
advance the objectives of the Institution as far as shall be in my power, provided that whenever I
shall signify in writing to the Honorary Secretary that I am desirous of withdrawing. I shall,
after the payment of any arrears which may be due by the period, be free from this obligation. I
certify that the statements given above are correct.

Signature: Date:

3. PROPOSER (Must be a Member of UIPE who is fully paid up and must be of the same
discipline as the applicant). (This is not applicable for student member applicants)

I, the undersigned, having read the form and report (where applicable) hereby propose/support
the candidate from personal knowledge as a person worthy of admission in the class of
membership applied for and I certify the correctness of the parts I have initialed. “I am fully
aware that proposing an applicant without reading the reports will be considered unethical and
bad professional conduct.

Signed: Class of Membership:(Member or Fellow)

Names in block letters

Engineering Discipline……………………………………………………………………...

Address for communication:

Tel: .................................. Email: …………………………. Date…………………………

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4. SECONDER (Must be a Member of UIPE who is fully paid up and must be same
discipline as the applicant). (This is not applicable for student member applicants)

I, the undersigned, having read the form and report (where applicable) hereby propose/support
the candidate from personal knowledge as a person worthy of admission in the class of
membership applied for and I certify the correctness of the parts I have initialed. “I am fully
aware that proposing an applicant without reading the reports will be considered unethical and
bad professional conduct.

(Signed: Class of membership: :(Member or Fellow)

Name in Block letters:

Address for communication:

Engineering Discipline…………………………………………………………………

Tel…………………………… Email………………………… Date………………………

5. APPROVAL BY THE UNIVERSITY OR TECHNICAL COLLEGE (for student

members only)

Name of University or Technical College………………………………………………...

Department…………………………………………………………………………….

Course being followed: ………………………………………………………………….

Registration No: ………………………………………………………………………..

Student No: …………………………………………………………………………….

Year of Study (e.g. 1st 2nd, 3rd or 4th)………………………………………………………

Expected year of Graduation …………………………………………………………

Name of Dean or Head of Department: ……………………………………………….

Signature……………… ……Date…………………………. Stamp………………………