This form is for new applicants only.
I, the undersigned, having read and understood the requirements
for accreditation, wish to express my support for our profession
and be accredited as a professional researcher and associate member** of ACPQ.
Candidate:
Dr
*Lastname:
*Firstname:
Mr.
Ms.
Current position
*Title:
*Institution:
*Address:
*City:
*Postal code:
*Tel: (Office):
Ext:
Fax:
*E-mail:
*Password:
*Rewrite your password :
Education and training
*Ph.D. diploma conferred (year of graduation
yyyy):
*Graduated from (
Institution):
*Country:
Experience and awards
*Are you currently, under a career development
award program:
Yes
No
Source (government agency, private foundation, others):
Expiration (
mm/
yyyy):
/
*Have you retired from the profession:
Yes
No
If yes,
as of (
yyyy)
*Are you, currently, or have you ever been, the recipient of an operating grant:
Yes
No
Date of expiration of your current, or
last, operating grant (
mm/
yyyy):
/
Source (government agency, private foundation, others):
Your field of research:
There remain to you
characters
Subject matter and central theme of your research program:
There remain to you
characters
Submitted:
2010 / 09 / 06
*Required fields: this information is
necessary for the study of your application. ACPQ will only process
completed accreditation requests.
**Associate member's status is approved
and granted upon ratification by ACPQ of the accreditation request.
Accreditation grants the researcher the titles, rights
and privileges of a professional researcher and those of an associate member
of ACPQ.
To become an active member
Policy of confidentiality and protection of personal information 
