License Application Fellow of CSI (FCSI®) – New Pathway Please enable JavaScript in your browser to complete this form.The FCSI® requires applicants to complete an approved education path. CSI currently offers two paths to earn the FCSI®: CIWM Path – As of the approved education path to earn the FCSI® has been updated to require an applicant to hold: The CIWM designation One of the following designations: PFP®, CIM®, MTI®, IQPF, CFP®, CFA®, CLU®, RFP FSDC Path – Until December 31, 2025, an applicant can follow the previous education path with the following requirements: Hold one of the following designations: PFP®, CIWM, CIM®, MTI®, IQPF, CFP®, CFA®, CLU®, RFP Complete the Financial Services Industry: Business Drivers and Challenges (FSDC) course Complete two courses from a different stream than that leading to the Designation(s) you already hold. Please visit FCSI® approved education path page for more details. External Designation Recognitions are subject to CSI’s External Designation Recognition policy and fee.Please select the education path you followed to earn the Fellow of CSI (FCSI®) license: *—- Select education path —-FCSI® (CIWM path)FCSI® (FSDC path)PERSONAL INFORMATIONStudent ID *Identity Verification Birthdate *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please indicate your name (including any initials used) exactly as it appears on your government-issued photo ID. *FirstMiddleLastGender *FemaleMaleNon-BinaryLanguage preference for communication *EnglishFrenchPreferred Email Address *Alternate Email AddressPhone number to reach you *PersonalBusinessBothPersonal Phone *Business Phone *Address *Home AddressBusiness AddressBothHome Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl 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(Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryBusiness Branch Transit Number (if applicable)Employee NumberEmployerJob TitleBusiness Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryTo which address would you like us to send your Certificate *Business AddressHome AddressWhich address would you like listed in our FCSI® directory? *Business AddressHome AddressI do not wish to have my address listedFCSI® EDUCATIONAL REQUIREMENTSa. Please indicate the designation you hold and are using towards achieving the FCSI®. * NOTE: External Designations are subject to CSI’s External Designation Recognition policy and fee. See details at www.fcsi.ca.Please indicate the designations you hold and are using towards achieving the FCSI®. * NOTE: External Designations are subject to CSI’s External Designation Recognition policy and fee. See details at www.fcsi.ca.Designation *Year granted *Designation *Year granted *b. Two (2) Additional CSI Courses Courses must be from a different stream than that leading to the Designation specified in item a). For additional information, please visit the Learning Path section on the FCSI® website at www.fcsi.ca.CSI Course (1) *Year Passed *CSI Course (2) *Year Passed *c. Financial Services Industry: Business Drivers and Challenges course (FSDC)Year Passed *FCSI® DECLARATION AND SIGNATURE OF APPLICANTDeclare *I declare that I have completed this application as completely as I am able and I hereby apply for the Fellow of CSI (FCSI®).I confirm that:WORK EXPERIENCE REQUIREMENTS *I declare that I have worked in the financial services industry for seven (7) of the last ten (10) years. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).WORK EXPERIENCE REQUIREMENTS *I declare that I have worked in the financial services industry for seven (10) of the last ten (15) years. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).EXPERIENCE VERIFICATION CONTACT INFORMATION Please provide contact information for the person (or persons) who will be able to verify your work experience declaration. On this application, you are required to provide details on your length of employment within each position you have held, which will allow CSI to affirm that the 7 years out of the last 10 have been fulfilled. However, you are given the option of providing one or more verifiers. For example, if your current supervisor is able to confirm all of your past experience, then you will require only one verifier. If, however, your current supervisor is not able to verify all past experience, then you will need to include your current supervisor (for current position) and one or several past supervisors to cover the other positions you have provided for the fulfillment of the required experience. Provision of this contact information is your acknowledgement that CSI may retain this information on your file and contact the individual for this purpose only. EXPERIENCE VERIFICATION CONTACT INFORMATION Please provide contact information for the person (or persons) who will be able to verify your work experience declaration. On this application, you are required to provide details on your length of employment within each position you have held, which will allow CSI to affirm that the 10 years out of the last 15 have been fulfilled. However, you are given the option of providing one or more verifiers. For example, if your current supervisor is able to confirm all of your past experience, then you will require only one verifier. If, however, your current supervisor is not able to verify all past experience, then you will need to include your current supervisor (for current position) and one or several past supervisors to cover the other positions you have provided for the fulfillment of the required experience. Provision of this contact information is your acknowledgement that CSI may retain this information on your file and contact the individual for this purpose only. From (YYYY-MM)To (YYYY-MM)Organization NameNameFirstLastEmail AddressPhone NumberLanguage preference for communicationEnglishFrenchFrom (YYYY-MM) To (YYYY-MM)Organization NameNameFirstLastEmail AddressPhone NumberLanguage preference for communicationEnglishFrenchFrom (YYYY-MM)To (YYYY-MM)Organization NameNameFirstLastEmail AddressPhone NumberLanguage preference for communicationEnglishFrenchENDORSEMENT REQUIREMENTS *I declare that my supervisor will endorse me for the FCSI® credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).I declare that an active Fellow of CSI will endorse me for the FCSI® credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).ENDORSER CONTACT INFORMATION Please provide contact information for your endorsement declaration. Provision of this contact information is your acknowledgement that CSI may retain this information on your file and contact the individual noted for this purpose only. Name *FirstLastOrganization Name *Email *Phone *FIT AND PROPER REQUIREMENTHave you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?, Insurance Regulator, FINRA, etc.)?Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?YesNoAre you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt? Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?YesNoHave you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?YesNoHave you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?YesNoIf you have answered “Yes” to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action taken. Any information you provide will be collected, stored and used in accordance with applicable law and our privacy policy and will be shared with the Designation Ethics Committee to determine your suitability for the designation. * “Criminal offence” excludes an offence (i) under a provincial regulatory statute, such as the Highway Traffic Act, unless the provincial statute is specifically listed above and unless the provincial conviction involved an offence of dishonesty or theft, such as perjury or subornation of perjury, false statement, fraud, embezzlement, or false pretense, or any other offense the commission of which involves some element of deceit or untruthfulness, and (ii) an offence punishable by summary conviction only that is not an offence of dishonesty or theft. Please attach all relevant paperwork * Click or drag files to this area to upload. You can upload up to 20 files. INDUSTRY CONTRIBUTION REQUIREMENTS *I understand, and agree to comply with the FCSI® Industry Contribution Requirements to complete a minimum of 12 hours per calendar year as set out in the FCSI® Industry Contribution Assessment Tool.You are not required to submit your documentation on an annual basis, however from time to time some members may be subject to random audits.TRADEMARK LICENSE AGREEMENT *By signing below I confirm that I have read and consent to the terms and conditions of this Information Release Consent.Signature * Clear Signature Next