Professional CIO Application

 

Personal Details


First name*
Surname*
ID / Passport No. *
Cell Phone No:*
-
E-mail:*
Preferred method of contact?
Gender*
Race*
Existing IITPSA Membership No. (if applicable):
Current CIO Company name:*
Physical Address:
Postal Address:*
Where did you hear about the IITPSA Prof CIO designation?

Education Details


Degrees, Diplomas, Certifications

Degree / Diploma / Certification 1
Degree / Diploma / Certification 2
Degree / Diploma / Certification 3
Degree / Diploma / Certification 4
Degree / Diploma / Certification 5
Please attach certified copies of your degrees / diplomas / certifications, as well as an updated, comprehensive CV.

By submitting this form, I hereby apply to IITPSA for consideration of the designation award of Professional CIO. I understand that this designation is intended for senior CIOs who have the requisite qualifications and relevant senior level ICT leadership experience. I understand that I shall be required to complete a SFIA self-assessment and undergo a peer review. I acknowledge that the information provided is correct and true, to the best of my knowledge. I understand that, if my application is successful, some of my personal information will need to be shared with SAQA, twice yearly, as the holder of a professional designation. I confirm that I shall abide by the prevailing IITPSA ethical codes of conduct and practice at all times. I further agree to pay my annual membership fees and to undertake the required CPD activities to keep my professional designation current. I understand that failure to do so will result in my Professional status being revoked.

I agree and consent to all of the above. I understand that ticking this block in agreement with the above statements is the same as me providing a hand written signature on this document. *
Date:*