EXAMINATION APPLICATION FORM – DECEMBER 2016 Join BCS – Register online!

EXAMINATION APPLICATION FORM – DECEMBER 2016
All sections of this form must be completed.
Have you sat an IMIS exam? (please tick)
Yes
No
Your IMIS or BCS reference/membership number:
Join BCS – Register online!
To apply for IMIS Examinations you must be a BCS member. If you are not yet a BCS member, you can apply for membership
online at www.bcs.org/join.
For help, please contact the BCS Customer Service team on +44 (0) 1793 417424 or via www.bcs.org/contactbcs
Fees and entry closing dates can be found at www.bcs.org/IMIS
1. Your details – Details need to be candidates own information. These details will be used to generate your membership record
Please write clearly in BLOCK CAPITAL letters using black or blue ink.
Title:
Mr
Mrs
Miss
Ms
Other
Family Name:
First Name(s):
/
Date of Birth:
Mailing Address:
Address 1:
Address 2:
Address 3:
Town:
Country:
/
DD/MM/YY
County/Region:
Postcode:
Personal Telephone Number:
Personal Email Address:
BCS, The Chartered Institute for IT, is the business name of The British Computer Society (Registered charity no. 292786) 2013
BC410/HEQ/FORM/1113
2. College details (Mandatory) Please fill this out in full.
This information helps BCS to monitor the performance of your Approved Centre.
Are you currently enrolled on a course of study towards IMIS Examinations?
() Your entry form will not be processed unless this section is complete.
Yes – please give details below.
No – please go to part 3.
Name of College
Type of course (full-time, part-time, distance learning)
3. Examination entry (Mandatory) Which examinations do you wish to sit?
Please complete this section for the modules you wish to take at the next examination session.
For full information on all our fees,
please visit www.bcs.org/IMIS
Your examination results:
When issuing results to you, a copy is also sent to your study college
Diploma
Higher Diploma
D1 Personal & professional practice in IS
Dec
H1 Management Information Systems
Dec
D2 Business Context of IS
Dec
H2 Information Systems Strategy
Dec
D3 Using ICT in an Organisational Environment
Dec
H3 Contemporary Issues in Systems Design
Dec
D4 Website Development
Dec
H4 Database Design
Dec
D5 IS in Organisations
Dec
H5 Project Management for IS
Dec
D6 IS Development
Dec
H6 Business IS Project
Dec
Please note: The Foundation Diploma qualification, level 3 has been withdrawn with immediate effect,
therefore this WILL NOT be offered in the December 2016 exam session.
BCS, The Chartered Institute for IT, is the business name of The British Computer Society (Registered charity no. 292786) 2013
BC410/HEQ/FORM/1113
4.Examination Venue (Mandatory)
Are you sitting your examination at your college in Section 2 of this form?
Yes
No
If NO then please declare where
5.Payment of fees (continued)
FEES: (Read fee list carefully at www.bcs.org/IMIS)
Examination fees (total of section 3 of this form)
Application Fee (payment required when starting a new level only)
Local Fee: (Candidates in Trinidad and Zambia only)
BCS Membership fee (if applying via this form)
TOTAL:
£
Payment must be in pounds sterling (£) and for the correct amount calculated as the Grand Total.
Membership annual fee:
Annual [
]
or
Full course (4 years) [
]
6.Payment of fees (continued)
You can pay by cheque (please make cheques payable to IMIS), credit card or debit card (please tick as
appropriate).
I have enclosed the following for the full sum above:
Bankers Draft
Personal Cheque
Debit/Credit Card
*For security reasons to pay by credit/debit card please contact our Customer Service team on +44 (0) 1793 417424. Do not write
your credit/debit card details on this form.
----------------------------------------------------------------------------------------------------------------------------- --------I wish to pay by
Lloyds Bank PLC
IBAN: GB26LOYD30984179953768
Account No.: 79953768
Bank Transfer:
5 High Street
Sort Code: 30-98-41
Swindon
Swift code: LOYDGB21106
Wiltshire
SN1 3EN
PLEASE NOTE: YOUR PAYMENT MUST INCLUDE ANY BANK CHARGES THAT ARE LIKELY TO BE INCURRED IN THIS TRANSFER
BCS ARE NOT LIABLE FOR THESE CHARGES AND THIS MAY RESULT IN YOUR APPLICATION NOT BEING PROCESSED IF PAYMENT IS
SHORT
Please ensure you fill out the payment advice number from your bank transfer in the section above and
provide a copy of the SWIFT transfer payment form. If someone is paying on your behalf, please provide their
FULL name below:
Failure to fill out this information will result in your application not being processed
BCS, The Chartered Institute for IT, is the business name of The British Computer Society (Registered charity no. 292786) 2013
BC410/HEQ/FORM/1113
7. Your personal Information
We recognise that your privacy is important to you.
We will use the information you give us to provide BCS services to you, conduct market research and advise you about other products or
services which may be of interest to you.
You can opt out of emails from us at any time by contacting our Customer Services team ( www.bcs.org/contactbcs) or phone: +44(0) 1793 417424.
Your personal information will be kept securely and subject to the declarations in section 8 (Declaration) below, we will not disclose this to any third parties without your
permission, unless we are required by law or other court order to do so
.
Full details of our data protection and privacy policies are online at www.bcs.org/privacy
The personal information provided by you to BCS will be used by BCS for the purposes mentioned in our data protection and privacy policies and also by BCS
for the purposes mentioned in section 8 below.
8. Declaration – to be signed by all candidates
I declare that BCS:
a. may use and process my personal information to administer this Entry application form, for legal and regulatory compliance and for the other purposes mentioned in this
form and for those of other related BCS activities; and
b. may use, process and disclose my personal information, including any sensitive personal data as defined in the Data Protection Act 1998 (such as membership status and the
results of my assessments, exams and project submissions for BCS qualifications) to my Approved Centre for the purposes of the on-going development and maintenance of
BCS qualifications, to the UK Visa & Immigration or other government agencies for crime prevention or so that BCS or they may check and monitor my attendance and progress on
the course at my Approved Centre running BCS qualifications.
I acknowledge that for the purposes of the Data Protection Act 1998, the Data Controller in relation to any personal information that I
Provide to you is BCS, the Chartered Institute for IT.
Please read this declaration carefully before signing.You may contact customer services for further information if you do not understand any part of the
declaration.



Please check all details carefully, as later amendments cannot be guaranteed.
Please ensure that you have attached the correct fee.
Return this form to BCS office (see address below) by the correct closing data. (Entry closing dates can be found at www.bcs.org/heq).
By signing this Entry application form, I confirm that:
a. the information given on Entry application form (including my declarations in section 8 above) is correct; and
b. I have read and understand your data protection and privacy policies and the effect of my giving the permission described in (b) above; and
c. I consent to BCS using my personal information for the purposes in your data protection and privacy policies and in this Entry application form
including the limited disclosure described in (b) above.
Signature
Date
PRINT NAME
Email to [email protected] or post to IMIS department, BCS, The Chartered Institute for IT, First Floor, Block D,
North Star House, North Star Avenue, Swindon, SN2 1FA United Kingdom. Tel: +44 (0) 1793 417424.
Institute for the Management of Information Systems
Now part of BCS, The Chartered Institute for IT
First Floor, Block D, North Star House, North Star Avenue,
Swindon SN2 1FA, United Kingdom
[email protected]
+44 (0) 1793 417 450
BCS, The Chartered Institute for IT, is the business name of The British Computer Society (Registered charity no. 292786) 2013
BC410/HEQ/FORM/1113