Certification for Educators Grandfathering Provision Application v.2

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NOTE: (1) THIS FORM IS LIMITED TO FULL TIME FACULTY FROM ACCREDITED UNIVERSITIES / COLLEGES IN NORTH AMERICA, EUROPE, PHILIPPINES AND AUSTRALIA. (2) APPLICANTS FROM OTHER COUNTRIES MUST CONTACT THE OFFICE OF THE CHAIRMAN (chairman@theiic.org) FOR CONSULTATION BEFORE APPLYING UNDER THIS CERTIFICATION PROGRAM. **ADJUNCT FACULTY ARE NOT ELIGIBLE FOR CERTIFICATION UNDER THIS PROVISION.

INSTRUCTIONS: Educators may be eligible for the Certification via Educator Program based on education, experience, development or delivery of courses in the appropriate areas of internal controls, or publication of high quality articles in areas of internal controls in peer-reviewed journals. Areas include Accounting, Computer Science/IT, Information Security, Physical Security, Management, Quality Controls, etc. Educators must be employed full-time as a faculty member at an accredited university as recognized by the Association of Schools & Universities (for U.S. schools) or an acceptable accrediting agency (for non-U.S. schools). Educators receive a 50% discount on application fees and annual renewal fees, as well as additional discounts on training and conferences. Proof of full-time employment may be requested.

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Certification * This field is required.Select which certification you are applying for by clicking on the appropriate circle.

CICA

CCS

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Applicant Instruction Acknowledgement * This field is required.Check the circle below. This acknowledgement is required.

I have read, understand and agree to the application instructions and requirements above, including the timing process for processing application, notification of committee;s decision, mailing and receipt of certificate (if approved)

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Applicant Employment Declaration* This field is required.Check the square below. This declaration is required.

I AM employed as a full-time faculty member at an accredited college or university.

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Application Date

Date

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Personal Information

Please include all the personal information requested here to the best of your ability.

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Salutation* This field is required.

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First Name* This field is required.

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Middle Name

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Last Name* This field is required.

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Home Address* This field is required.

Street Address

P.O.Box (if any)

City

State / Province

Postal/Zip Code (If you are applying from a country that does not utilize postal codes or zip codes, Type “N/A” or NONE. This field is not for PO Boxes)

Country

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Personal E-mail* This field is required.

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*Very Important: you cannot use your work address for your local residence or your work email as your personal email. Likewise, you MUST include both your personal and work email addresses. The preferred email address you provide is the unique identifier that is used for your account. If you are intending to obtain a second certification with TheIIC you must utilize a different email address for the second certification. If you do not provide a different email address your application for the second certification will be halted until a new email address is provided as the unique identifier.

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Academic Employment Information

Enter all required information regarding your academic employment to the best of your ability.

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Academic Institution* This field is required.

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Title

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Your Faculty Webpage URL * This field is required.

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Work Mailing Address

In the spaces below provide your work address at your institution of higher education, including the name of the school and the department you are a member of. Be sure to include all information requested in order than materials mailed to you are received as quickly as possible.

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Work Address* This field is required.

School/Department

Street Address

City

State

Postal/Zip Code (If you are applying from a country that does not utilize postal codes or zip codes, Type “N/A” or NONE. This field is not for PO Boxes)

Country

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Personal Phone* This field is required.

Country Code

Area Code

Phone Number

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Work Phone* This field is required.

Country Code

Area Code

Phone Number

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University E-mail* This field is required.Note: User domain email (.edu) MUST be provided.

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Preferred Mailing Address* This field is required.

Business

Home

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Preferred E-Mail Address* This field is required.

Business

Home

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Have you ever been convicted of a felony?* This field is required.

Yes

No

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If Yes, explain: (Limit 100 words)

0/100

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Qualifications

Be sure to complete all required questions regarding your qualifications below. Do not leave any question unanswered. Click "Next" to start this section.

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Highest Completed Academic Degree* This field is required.

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Academic Employment Status* This field is required.

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Input URL of Your Faculty Webpage* This field is required.Copy and paste the url of your faculty webpage here

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Check Applicable Box:* This field is required.

*I have taught a minimum of 4 courses in Internal Controls and/or related fields for each of the past 3 years

*I have published peer reviewed scholarly works in the areas of Internal Controls

*I have both taught a minimum of 4 courses AND published peer reviewed scholarly works in the areas of Internal Controls

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List all Internal Controls related courses taught, including credits awarded for each: (Limit 100 words)

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Click to Upload Submissions of publications referenced above in publication format only.

Drag and drop files here

Select files to upload

Max. file size: 1.0MB

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Please include anything you wish to add to your application here: (Limit 100 words)

0/100

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Applicant's Electronic Signature

WARNING: UNSIGNED APPLICATIONS WILL BE REJECTED!

Click on "Next" below and follow the directions given to sign electronically.

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Type your name in the box below, followed by /es/ to represent your signature* This field is required.

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Submit and Pay

Click on "Next" below and then click on Credit Card. Then Click on Next and you will be directed to Review and then Submit. Review your submission, then Click on Submit to pay the application fee. A hard copy of the application will be attached to the confirmation email you will receive from TheIIC. Download the hard copy and print it out for your records.

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Choose your method of payment:* This field is required.

Credit Card