All fields are mandatory unless otherwise indicated.

Commercial Organisation Name:

MAIN CONTACT DETAILS:
If the main contact changes or their details change, please email communication@ircmcic.org with updated details, with your Commercial Organisation name in the Subject line.

Name:
prefix ---MrMrsMissMsDr (medical doctor)Dr (educator)Other (details found in Additional Information box below)
first name
middle name/initial (optional)
last name
suffix (please put each suffix on a new line)

Position held in the Commercial Organisation:

Email:
Your email address will only be used to contact you in relation to your entry on the Directory. If your email address changes, please email communication@ircmcic.org with updated details, with your Commercial Organisation name in the Subject line.

Telephone number:
Your telephone number will only be used to contact you in relation to your entry on the Directory.

COMMERCIAL ORGANISATION ACCREDITATION:

Date Commercial Organisation applied to be Registered on the IRCM CIC’s Directory (DD/MM/YYYY):

Accreditation applied for:
---Coaching onlyMentoring onlyCoaching and MentoringOther (further details entered in the Additional Information box below)

Please enter a summary of your Coaching and/or Mentoring service or product.
If you provide more than one Coaching and/or Mentoring service or product, please email the summary with full details (as below) to communication@ircmcic.org, with the name of your Commercial Organisation in the subject line.

Please upload your Coaching and/or Mentoring business offering:

Please upload the application process and where applicable, the selection process, of the Coaches and/or Mentors you employ or represent:

Please upload your Codes of Conduct including all Standards and Ethics:
Please highlight where the IRCM CIC’s Codes of Conduct are included or referred to.

Please upload your Core Competencies:
Please highlight where the IRCM CIC’s Core Competencies are included or referred to.

Please upload your Disciplinary Procedure:
Please highlight where the IRCM CIC’s Disciplinary Procedure is included or referred to.

Please upload your Complaints Procedure, including outcomes and sanctions:
Please highlight where the IRCM CIC’s Ombudsman Service is included or referred to.

ADDITIONAL INFORMATION (Optional):
Please enter any Additional Information relevant to your accreditation application:

We agree to abide by the declarations made when we REGISTERED on the IRCM CIC’s Commercial Organisation Directory.

We confirm that as the main contact, I am applying on behalf of this Commercial Organisation to gain an independent external verification of our programmes.

I confirm that the information submitted on this form, and through any additional emails, is complete and accurate.

By submitting this form, we give our authority for the information submitted on this form, as well as through other forms and communication methods to be included in detail on the IRCM CIC's Commercial Organisation Directory; initially, as ACCREDITATION APPLIED FOR and then as ACCREDITED once payment is confirmed and the IRCM CIC accreditation process has been successfully completed.