Name of Applicant (to appear on certificate):
 

Name of Present Employer:
 

Office Address:
 

Postal Code:
Office Telephone:
Fax:
e-mail:
 

Home Address:
 

Postal Code:
Home Telephone:
Fax
e-mail:
 

Time slots of Broadcasts                Length of Appearance Air Times
 
 
 
 
 
 

List Software and Hardware available
 
 
 
 
 
 
 
 

EDUCATION:
 

University - College - Degree: Department/Specialization:
 
 

Year completed:
 
 
 

Other Relevant Course Qualifications: (List)
 

a) Institution - Course - Hours - Credits
 
 
 

b) Institution - Course - Hours - Credits
 
 
 

c) Institution - Course - Hours - Credits
 
 
 

d) Other
 
 

Previous Employer(s)
 

a)
 
 
 

b)
 
 

Other Relevant Professional Employment:
 
 
 
 
 

Membership in Relevant Associations (list names and dates joined)
 
 

Video and Audio Recordings (DVDs or tapes are to be provided in four copies for the use of three reviewers from the CMOS Endorsement Committee, plus one for filing).

Please provide details of your recordings, give details regarding the dates made, names of stations, time slots, air times, names of any other persons on the recording, etc.)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Declaration of witness

I certify that the statements made by the applicant, the contents of the recordings provided and the attachments to the application form, are true and complete.
 

Name:
 
 

Signature: ..........................................

Date: ..................................................
 
 
 
 

Completed forms and cheque are to be sent to:

Executive Director
Canadian Meteorological and Oceanographic Society
P.O. Box 3211
Station D
Ottawa, ON, K1P 6H7
Canada
Telephone / Téléphone: 613-990-0300
Fax / Télécopieur: 613-990-1617
Email / Courriel: cmos@cmos.ca

Revised: June 16, 2008
 
 

Homepage URL: http://www.cmos.ca/endorseeap.html