This form should be signed by the Training Director.
All fields on this form are mandatory unless otherwise stated

Name of the Course/Workshop:
Abbreviation of Course/Workshop (if applicable):

Type of Course/Workshop:

The organisation acknowledges that my signature on this Information Statement attests that they understand and certify that the following statements are true and correct.

This course or workshop meets the IIC&M’s

accreditation requirements.

I confirm that this course:
- ,
and is
- available in (please enter the language(s) in which the course(s)/workshop(s)are trained, using a comma (,) to separate the languages)

I pledge that the information provided in this Information Statement, the detail, the material, and the evidence of our training course or workshop, which we have submitted to gain Accreditation by the IIC&M, is honest and genuine.


Mentoring Courses/Workshops only:

What is the mentoring niche?

What is the minimum number of years experience in this niche will the students have?
minimum requirement is 0 years and maximum requirement is 5 years

All Courses and Workshops are required to complete the following:

Recognition of Prior Learning (RPL) available for this course/workshop.

If RPL is available, how has the RPL been defined?
please enter none if there is no RPL available for this course or workshop

These (RPL) hours the student, to complete this course or workshop.

Hours of specific training is .

Direct contact hours of training is .

The student should take no longer than to complete this course/workshop.
This is important for Level 7, Level 6, and Level 5 courses which are normally based on additional requirements outside the direct contact hours of training. Please enter the number of months that is allowable for the student to complete this course. Where this is a Level 4 or Level 3 please enter the number of hours.

Home studying is .

Reading that is set as part of the course/workshop agenda is .

Additional reading that is not set as part of the course/workshop agenda is .

Outside research is .

written submissions is/are included.
Please enter the number of written submissions that are included.
If none are included (i.e. for workshops, please enter 0.)

The students mentored by a Mentor.

The students subject to a Skills Assessment.

The students access to Support Coach(es) or Mentor(s).

The are included.

right click and select to open in a new window or tab
Coaching Core Competencies.
Mentoring Core Competencies.

I uploaded the .
- Coaching Core Competencies Mapping
- Mentoring Core Competencies Mapping

The agenda been uploaded.

The course material been submitted.

The trainers material been submitted.

The methods and variety of training include:

The following back-up and support is available during training:

The following back-up and support is available after training:

The following marketing methods and materials are used:

To award a qualification for this course, we assess the overall training in the following way:
Please include all elements where the course/workshop is assessed i.e. skills assessment, written submissions, practicals, overall assessment, etc.

We submitted our accounts.

It maybe that one or more people fill one or more of these roles.
Where the course is a coaching course it is important that the faculties accreditations are coaching accreditations.
Where the course is a mentoring course it is important the the faculties accreditations are mentoring accreditations.
Where the course is a combination of coaching and mentoring it is important that the course creator and the faculty are represented with both coaching and mentoring accreditations.

Please enter the name and their membership (and where applicable, accreditation) level.:
- Course Creator:
- Director of Training:
- Course Manager:

Please enter the name or all the names and accreditation level of the people who are in the following elements of your faculty.
Where you do not have a faculty member in a specific category, please enter 'none'.
- Lead Trainer(s) (and in which element of the course/workshop they are the lead trainer):

- Trainer(s) (and in which element of the course/workshop they are a trainer):

- Mentor(s) (if applicable):

- Skills Assessor(s) (if applicable):

- Support Coach(es) or Mentor(s) (if applicable):

- Qualification Assessors (if applicable):

- Additional faculty member(s) and their position(s) (if applicable):


Any additional information (optional):

We acknowledge that my electronic signature on this Information Statement attests that we understand and certify that these statements are true and correct.

Organisation Name: