Royal Town Planning Institute

41 Botolph Lane, London, EC3R 8DL

Charity registered in England 262865 and Scotland SC037841

Application for Licentiate Membership

All graduates of RTPI-accredited courses must apply to become Licentiates of the Institute before commencing the
structured programme of professional planning experience leading to the Assessment of Professional Competence.

Before applying for Licentiate Membership, please ensure that you meet the required criteria as laid out in the
Declaration on page 4 of this application form.

You can type directly into this form, but, because of software restrictions, you cannot save a copy of the completed form
on your computer. You cannot also submit it online. The completed form must be printed and returned to the RTPI with
original signatures.

If you are unable to type into this form, first ensure that you have the most recent version of Adobe Reader® installed
on your computer, and then open the form from Reader.
.
A. Personal information

Title Mr Miss Mrs Ms Dr Other Please specify

Family name

Previous family name

Forenames

Preferred Forename

Address

Home telephone

Work telephone

Email

RTPI membership number, if applicable

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 B. Education
Please provide information on all of the RTPI-accredited degrees you have completed. You must attach
proof of all of these qualifications in the form of a photocopy of your certificate, a letter from the university
or official transcript. Please attach additional sheets if necessary.

RTPI-accredited undergraduate degree (if applicable)

University

Title of degree

Date of commencement

Date of successful completion of degree (date

degree formally conferred by the university)

Full- or part-time? Full-time Part-time

Proof of degree attached to application form

RTPI-accredited postgraduate degree (if applicable)

University

Title of degree

Date of commencement

Date of successful completion of degree (date

degree formally conferred by the university)

Full- or part-time? Full-time Part-time Distance learning

Proof of degree attached to application form

C. Data Protection

The information you provide in this application form will be held on the Institute's
database in accordance with the Data Protection Act 1998. This information will be used
only for administrative purposes, to keep you informed of the Institute's activities and to offer goods and services
of the Institute, including the services provided by its partners.

Your email address

The Institute may need to contact its members by email from time to time. Please let us know if you are happy
to receive email communications from the Institute.
NB: Your email address is essential for informing you about the Assessment of Professional
Competence.
Please tick here if you are happy to receive any email communication from the Institute. This includes
emails relating to the Assessment of Professional Competence and any other email communication from
the Institute and its partners.

Please tick here if you are happy to receive only email communications relating to the Assessment of
Professional Competence.
Third-party mailings
Please tick here if you are happy to receive third-party mailings (these are communications from
organisations other than the Institute and its partners).

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 D. Current Employment

Date of commencement of your post

Job title

Employing organisation

Address of
organisation

E. Application Check List

I have included the following with the completed application form:
Proof of sucessful completion of all RTPI accredited degree courses in the form of a copy of the degree certificates,
official transcripts or letters from the universities.

Payment of the £50 Licentiate registration fee - either a cheque or credit/debit card details.

F. Declaration

Licentiate

I confirm that I have successfully completed my accredited qualification and am now in professional
employment which to the best of my knowledge is eligible towards the practical experience requirements of the
APC. I will notify the RTPI directly of any changes to the information contained in this form, including a change
of employer.

Signature Date

Employer (the Licentiate's line manager, or other suitable individual e.g. training manager)

I confirm that the above named applicant is employed in a professional capacity by this organisation as he/she
begins the practical experience requirement of the Assessment of Professional Competence.

Name of organisation

Name of signatory

Job title of signatory

RTPI membership number of signatory (if applicable)

Day time telephone

Signature Date

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 G. Licentiate Registration Fee Payment Details

The Licentiate Registration Fee of £50 is payable to the Royal Town Planning Institute at the point of
application. Payment is by cheque, debit or credit card only and must be included with the application form.
There may be a delay in processing applications not accompanied by the correct fee.

Please note that the Institute does not accept BACS payments.

Please indicate below the amount of your payment.

Licentiate registration fee: £50

Payment by cheque
Please make cheque payable to the RTPI and attach it to the front of the application.

Payment by credit or debit card

If you prefer to make a card payment please provide the card holder details below. Please be aware
that we accept only MasterCard, Visa, Visa Debit, Maestro (Switch) or Solo.

Card type MasterCard Visa Visa Debit Maestro (Switch) Solo

Card holder's name (as

it appears on the card)

Billing address

Card number

Security code (last 3 digits

Expiry date
on signature strip)

Valid from date (for Issue number (for some

some Visa Debit, Maestro, Maestro, Switch or Solo
Switch or Solo cards only) cards only)

Card holder signature Date

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 H. Equality and diversity

The Institute regularly monitors the profile of itsmembership in order to comply with equality and diversity
legislation. Although it is not compulsory to provide the following information, it will be an invaluable aid for the
Institute to monitor its membership.

This information will be held on the Institute's database in accordance with the Data Protection
Act 1998. It will be treated confidentially and will not be divulged to other parties.

This page will be removed from your application before it is considered by the Membership Panel.

1) Your date of birth

2) Your gender Male Female

3) Which ethnic category best describes you?

White or White British White Welsh White Irish
White
British White English White Northern Irish Irish Traveller
White Scottish Other Please specify:

Gypsy/ Gypsy/Roma
Roma

Black or Black African Black Caribbean

Black
Other Please specify:
British

Asian or Bangladeshi Indian Pakistani

Asian
Other Please specify:
British
Chinese or Chinese
Chinese
British
Mixed White + Black African White + Black Caribbean White + Chinese
White + Asian Other Please specify:

Other Other Please specify:

Information Information refused

refused

4) Do you have a disability as defined under the Disability Discrimination Act 1995?
Yes No

If yes, what is the nature of your disability?

5) Are you a UK national?

Yes No
If you are not a UK national, are you a national of another EU country?

Please specify which country

If you are not an EU national, what is your country of origin?

Please specify which country

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 The Young Planners' Network

The Young Planners' Network is a virtual community of planners in the early stages of their
professional careers throughout theUKandIreland. It provides a voice for all young
planners within the RTPI, helping members exchange ideas and information. It also
provides a forum for expressing views and ideas and co-ordinates opinion to help influence
the governance of the Institute.

Membership of the network means that you will receive regular email bulletins from the
RTPI, and will also be able to access resources available only to members on the network's
website (http://www.rtpi.org.uk/young_planners_network/), such as the database of network
members.

The website is updated regularly and contains plenty of useful information, including
meetings and events and relevant articles from Planning magazine. Membership of the
Young Planners' Network is FREE to Licentiate Members (and other eligible members of
the Institute).

How do I join the Young Planners' Network?

1. Register as a user of the RTPI website www.rtpi.org.uk

2. Register as an RTPI member and fill in your member profile
3. Visit http://www.rtpi.org.uk/young_planners_network/ and request access to the
network.

This is a simple, quick process which does not require you to complete an application form.

Your completed application must be returned to:

Membership Team
RTPI
41 Botolph Lane
LONDON
EC3R 8DL

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