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Confirmation of Registration
The Registrar,
The above applicant for registration has stated that he/she has been or is a member of your Association/Ordre/State Board and has granted permission to APEGGA to obtain additional information from sources it may deem necessary to the progression of the application.  Please complete the applicable items below and return this form to us by mail or fax, as soon as possible.  Thank you for your help.  Sincerely Mark Tokarik, LL.B, P.Eng., Director Registration.

Registration was first granted as a: 

 (Specify type of member or licensee) 


Application Received on:
Date of enrollment as a Member-in-Training:

Membership was resigned or lapsed (if applicable):                


Annual dues are/were paid up until:                           


Registration was granted on the basis of (1 + 2 + 3 or 4):
1) Having met the academic requirements as follows:  
  a) CEAB - accredited bachelor degree
  b) ABET - accredited bachelor degree
  c) MRA - accredited bachelor degree
  d) Unaccredited degree plus Confirmatory Examinations (please attach subjects/grades)
  e) Unaccredited degree plus North American post-graduate degree (please attach details of degree and discipline)
  f) Examination program (please attach subjects/grades)
  g) Passing the FE examination with a mark of  % for US applicants
  h) Experience in lieu examinations

Was confirmation of academic background received directly from the academic institutions?  If no, what was the source of the information/documentation?

Yes No

2) Having met the experience requirement of years of acceptable experience (and having passed the PE examination with a mark of % for US Applicants)
3) Having passed the Professional Practice Examination
4) By Mutual Recognition through:
a) Interprovincial Mobility Agreement/Inter-association Mobility Agreement
b) NAFTA - graduate of accredited program
c) NAFTA - graduate of non-accredited program
d) Prior registration in/transfer from/comity with 
  Having passed the Professional Practice Examination (if applicable)
Has this individual ever been subjected to any discipliary action?

Yes No
Please add any additional information relevant to the application, etc.
Signature Position  
Revised: January 10, 2000