Use Print command to print off this form:

Use Browser “back” button to return to site.

 

APPLICATION

PRINCE EDWARD ISLAND INSTITUTE OF AGROLOGISTS

 

____Agrologist-in-training              Permit to Practice Agrology             ____Transfer   _____Reinstatement

 

Name (please print)                                                                                                                            

                                                  Last Name                              First Name                          Middle Initial

 

Business Address                                                                                                                                                                                                                                                        

 

       Telephone                              Fax                             Email                                                                         

 

Home Address                                                                                                                                                                                                                                                                                               

                                                                                                                                                            

 

Telephone                              Fax                         Email                                                                                      

 

Preference for mailing purposes:   Business O    Home O

 

Academic History (Secondary/Post Secondary)

 

List training pertaining to your credentials/ability to practice agrology

 

REFERENCES

Included with this application form must be two letters of support, namely:

(1)               From your present employer.  If self-employed, a letter from an individual familiar with the service being offered.

(2)               From a professional agrologist familiar with your past performance and current responsibilities.

EMPLOYMENT

 

Name and address of employer

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         

                                                                                                                                                         

Full descriptive title of position                                                                                                 

 

Date appointed to present position                                                                                                     

 

If self-employed, state nature of business                                                                                             

 

Previous Employment

 

The applicant must also submit a letter specifying why they want to become an Agrologist in Training. The applicant must give examples of how being an AIT can help them further develop in their agricultural careers.

 

I certify the foregoing information to be true.  Upon acceptance of my application, I agree to be governed by the Act, By-Laws, Regulations and Code of Ethics of the P.E.I. Institute of Agrologists.

 

Date:                          20                      Applicant’s signature:                                                                

 

Application form and $15.00 application fee should be sent to:

 

Registrar

P.E.I. Institute of Agrologists

P.O. Box 2712

Charlottetown, PE

C1A 8C3

 

 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

For use of the P.E.I.I.A.

This application has been examined and the applicant is approved for a permit to practice Agrology as:

______ (AIT) ______ (P.Ag.) ______ (PPA)

Date:                                                  Registrar: