IDENTIFICATION

Member number Address

First name City Province/State

Last name Country Postal code

E-mail Telephone – Home Telephone – Work

INSTRUCTIONS

Depending on the period in which you were struck off the roll, please read the instructions below.

Remember to provide supporting documents for each activity. Refer to the Summary Table of Continuing Education Activities to find out which supporting documents are eligible.

Once you have filled out the form, save it and e-mail it along with the supporting documentation. Without the form, your request for the reversal of the decision to strike your name off the OIQ’s roll will be considered incomplete and denied.

2011-2013 PERIOD

Limits apply to the hours that you may report for the following activities:

Conferences, workshops, seminars, symposiums or conventions (limit of 15 hours) Delivery or preparation of a presentation or leading workshops as part of a conference,

seminar, symposium or convention (limit of 10 hours) Writing published specialized articles or papers (limit of 15 hours) Participation in technical committees (limit of 10 hours) Participation in research projects and self-study activities (limit of 5 hours)

2013-2015 & 2015-2017 PERIODS

Limits apply to the hours that you may report for the following activity: Participation in research projects and self-study activities (limit of 5 hours)

DECLARATION AND SIGNATURE

I solemnly certify and affirm that the information provided in this form and all attached documents is true, exact and unaltered.

Signature Date

TRAINING ACTIVITY REPORT FORM FOR THE REVERSAL OF A

DECISION TO STRIKE A MEMBER FROM THE ROLL

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca Last update : 2019-03-19

ACTIVITY REPORT – 2011-2013 PERIOD

ACTIVITY #1

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #1

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #2

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #2

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2011-2013 PERIOD (continued)

ACTIVITY #3

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #3

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #4

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #4

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2013-2015 PERIOD

ACTIVITY #1

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #1

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #2

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #2

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2013-2015 PERIOD (continued)

ACTIVITY #3

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #3

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #4

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #4

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2015-2017 PERIOD

ACTIVITY #1

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #1

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #2

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #2

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2017-2019 PERIOD

ACTIVITY #1

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #1

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #2

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #2

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca

ACTIVITY REPORT – 2017-2019 PERIOD (continued)

ACTIVITY #3

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location

(City/Province/Country) Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #3

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

ACTIVITY #4

Start date End date

Type of activity

Type of content (subject)

If other, specify

Name of the activity

Type of provider Provider

Location (City/Province/Country)

Duration in hours

REQUIRED SUPPORTING DOCUMENTATION – ACTIVITY #4

Document no. 1: File name

Document no. 2: File name

Document no. 3: File name

Ordre des ingénieurs du Québec

Gare Windsor, 1100, avenue des Canadiens-de-Montréal, Suite 350, Montréal (QC) H3B 2S2

514 845-6141 or 1 800 461-6141 ext. 2398 fco@oiq.qc.ca