CHARTERED INSTITUTE OF CERTIFIED SECRETARIES & REPORTERS NO. 6, LADIPO ADEYEMI STREET, ANTHONY VILLAGE P M B 038 SHOMOLU-LAGOS STATE. EXAMINATION ENTRY FORM Entry Form No: _________________________ April September Tick as appropriate Name (Surname First): ------------------------------------------------------------------------------------------------------------------------------Office Address: --------------------------------------------------------------------------------------------------------------------------------------Date of Birth: -------------------Age: ---------------Nationality: --------------------------- State of Origin -----------------------------------Telephone No. of Candidate: --------------------------------Email-Address: -------------------------------------------------------------------Membership Grade: -------------------------------------------Exam Centre Desired: -----------------------------------------------------------Tick which of the following Examination you are entering: 1. Confidential Secretaries/Official Reporters Qualifying Courses, (Intermediate Exam) 2. Administration and Management Courses, Professional Examination ( PE I & II Exam) INTERMEDIATE EXAMINATION 1. Data Processing and Application Programs 2. Shorthand Speed Writing 120 – wpm 3. Bi-Lingual Secretarial Practice 4. Office Information Technology Management 5. Financial Accounting PROFESSIONAL EXAMINATION PE I 1. Information Communication Technology 2. Organizational Behaviour and Methods 3. Corporate Secretarial Practice 4. Quantitative Techniques 5. Entrepreneurship Development PE II (FINAL) 1. Parliamentary and Judicial Procedures 2. Strategic Management 3. Public Accounting 4. Business Law and Government Relations 5. Problems and Cases (Assignment and Project Based) NB: Please tick appropriate box (es) on the examination subject required Examination fees: Please see examination regulations for fees appropriate to your desired examination as follows Examination fees for all subjects in each module or part are as follows: Intermediate N15, 000, Professional N16, 000 Amount enclosed N____________________(________________________________________________________) DECLARATION I ______________________________________________________________________________________________________ Hereby declare that the information given in this entry form are correct to the best of my knowledge and that I shall abide by the rules and regulations governing the Institute’s training and examinations. I also indemnify the Institute against any false information I may have given and hereby accept to be disqualified from writing the examination of the Institute or receipt of any result and certificate thereof if I am found to have deceived the Institute. Candidate’s signature ____________________________________________ Date__________________ Affix post stamp SPONSOR The entry form and the passport photograph should be endorsed by the sponsor being either the employer, HOD of academic institution or fully qualified and registered member of the Institute. It is dangerous to guarantee unknown person. Name of sponsor (in full) __________________________________________________________________________________ Address_________________________________________________________________________________________________ Nature of occupation/profession__________________________________ Rank/Status_________________________________ Signature _____________________________________________Date ______________________________________ FOR OFFICIAL USE ONLY 1. Examination Entry Form approved by: __________________________________________________________________ 2. Candidate Examination No: _____________________________________Centre_________________________________ PATICULARS OF AMOUNT RECEIVED Amount: N__________________________ (in words)__________________________________________________________ Bank___________________________________________________________________________________________________ Total Amount Received: __________________________________________________________________________________ Mode of Remittance: _____________________________________________________________________________________ Attach deposit slip Intermediate Part I Part II Remark Number of subject entered for Number of referrals Results Received by __________________________________________ Passed to ______________________________________ Processed by __________________________________________Checked by____________________________________ Receipt acknowledged by ________________________________Date__________________________________________ Notice dispatched ________________________________________Date___________________________________________ Certificate issued/dispatched _______________________________________________________________ Crossed checked________________________________________________________________________ Filed by _______________________________________Date_________________________________ Member