FEANI REGISTER

APPLICATION FORM
FOR ENROLMENT IN THE REGISTER
AND FOR THE TITLE OF EUROPEAN ENGINEER EUR ING
(Guide to the FEANI Register and an ea!"#e $or Pro$essiona# Re%ie& Re"ort'
htt"'((&&&)$eani)org se*tion + EUR ING , -
Nationa# Monitoring Co!!ittee (NMC- o$ Nationa# Registration Nu!.er

PERSONAL DATA
Ma#e Fe!a#e
(Type X in the appropriate square)
Fu## Na!e (Family name in uppercase):
Date o$ .irth:
Nationa#it/:
Te#e"hone: Fa:
E!ai#:
Address $or *orres"onden*e'


Version 2014 1
SECTION 0 SECONDAR1 EDUCATION
Fina# *erti$i*ate:

(Co"/ o$ *erti$i*ate atta*hed-
SECTION 2 HIGHER EDUCATION IN ENGINEERING
Institution a&arding degree'
Countr/'
Dis*i"#ine ' Date'
A*ade!i* a&ard ( Tit#e' A..re%iation'
Stud/ $ro!' To'
(Co"/ o$ *erti$i*ate atta*hed-
FOR COMPLETION 31 NMC
Progra!!e in*#uded in FEANI Inde' :
(According to the Guide : Art. 5.3a)
Duration o$ Progra!!e in FEANI INDE4' (U- : (T- :
Degree T/"e'
($or 3o#ogna "rogra!!es on#/-


Edu*ation outside o$ FEANI area re*ogni5ed as e6ui%a#ent to the
FEANI INDE4 (according to the Guide : Art. 5.3b) :
Progra!!e in Mathe!ati*s(S*ien*e in the INDE4 (according to the
Guide : Art. 5.a) :
7eri$ied ./ NMC
FCD SCD SC Integrated


Na!e'
Signature'
Version 2014 2
SECTION 8 SPECIAL CASES
TECHNICAL EDUCATION OTHER THAN SECTION 2
(A**ording to the Guide ' Art) 9):.-
Detai#s o$ an/ te*hni*a# edu*ation "ost se*ondar/'
Stud/ $ro!' To :
An/ tit#es a&arded; des*ri"tion and na!e o$ a&arding .od/'

(Co"/ o$ *erti$i*ate atta*hed-
FOR COMPLETION 31 NMC
State!ent o$ <usti$i*ation o$ assess!ent o$ e"erien*e to su""ort a""#i*ation'

SECTION : PROFESSIONAL ENGINEERING E4PERIENCE
!andidates should attach the "ollo#ing documents in one o" the three F$A%& languages ($nglish'
French' German):
() the completed )*ro"essional $ngineer $+perience ,ection- (si+ )e+perience criteria- related to
recent.long/term employments / see separate document.clic0 here)1
2) a !3' dated and signed on all pages' including details o" the employer(s)' positions held and
duration. 4ength o" document should be about one page A.
3) employers5 letters certi"ying.endorsing employment details. Those must be in one o" the three
F$A%& languages' or other#ise accompanied by a translation.
FOR COMPLETION 31 NMC
Pro$essiona# Engineering E"erien*e (1ears-'
Re6uired $or EUR ING' E
Additiona#' E Tota# re*ognised '
Countr/' E

7eri$ied ./ NMC
Na!e'
Signature'
Version 2014 3
SECTION 9 PROFESSIONAL TITLE
(I$ an/)
Tit#e: A..re%iation:
A&arded ./: Date :
SECTION = CERTIFICATION 31 CANDIDATE
& apply "or enrolment in the F$A%& 6egister and "or the a#ard o" the designation o" $uropean $ngineer
$76 &%G (,ee Guide Art. 5.3 or 5.)
& certi"y that the abo8e/mentioned in"ormation is correct and & agree to comply #ith the F$A%& !ode o"
!onduct. & agree that my data are stored in the F$A%& 6egister.
9ate: ,ignature:
&" name change due to marriage or other' please gi8e both names and con"irm #ith your signature:
%ames: ,ignature:
SECTION > ENDORSEMENT OF APPLICATION 31 NMC
0
st
Ea!ination
!erti"ied by %:! (name and signature):
6egistration date o" %:! :
2
nd
Ea!ination (i$ de$erred ./ EMC-
!erti"ied by %:! :
6egistration date o" %:! :
Version 2014 4
SECTION ? DECISION 31 EMC
0
st
Ea!ination : A**e"ted De$erred Re$used
Co!!ents :

Date : Na!e and Signature :
2
nd
Ea!ination : A**e"ted De$erred Re$used
(&" de"erred at (
st
e+amination)
Co!!ents :
Date : Na!e and Signature :
Version 2014 5