中華民國內部稽核協會

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1 國際內控自評師 (CCSA) 授證及專業名銜使用辦法第一條中華民國內部稽核協會 ( 以下簡稱本協會 ) 為讓國際內控自評師考試及格者於申請證書與使用專業名銜時能有明確之規範, 特訂定國際內控自評師授證及專業名銜使用辦法 ( 以下簡稱本辦法 ), 以資遵循第二條凡通過國際內控自評師考試及格者, 應檢附成績單, 填寫國際內控自評師 (CCSA) 證書申請表, 並備齊符合本協會所要求應檢附之專業資格證明文件, 依考試簡章所規定之四年有效期限內, 提前三個月向本協會完成國際證書之申請作業向本協會提出授予國際內控自評師證書之申請, 另須繳交申請費第三條申請國際內控自評師證書時, 應檢附下列文件 : 一一年 ( 含 ) 以上內部控制相關工作經驗證明, 例如 : 內控自評稽核品質保證風險管理或環境稽核等, 並填寫英文版經驗驗證表 (Experience Verification Form) 二國際內控自評師審核 ( 經驗 ) 表, 聲明有七小時以上之推動內控自評實務經驗凡未具有七小時以上之推動內控自評實務經驗者, 於申請證書時須修滿本協會最近二年所開設與內控自評有關之訓練課程達十四小時以上, 並請檢附國際內控自評師審核 ( 訓練 ) 表及內控自評訓練課程結業或學分證明影本三證書申請表及所須附件第四條所繳驗之相關文件, 若有塗改偽造假借等情事, 將喪失所授予之考試及格資格第五條考生於收到證書後, 請務必妥善保管若有遺失或須更名之情事, 須填寫更正考生資料 / 補發證書申請表, 並繳交證書工本費第六條本協會之授證典禮, 每年舉辦一次, 於年度研討會中予以表揚第七條取得國際內控自評師證書者, 須依規定持續進修未持續進修或持續進修時數不足者, 須於使用國際內控自評師名銜之前補齊, 否則不得使用國際內控自評師名銜針對不符合持續進修規定者, 若有相關人士詢問, 本協會將明確告知該員因持續進修時數未遵循規定, 不得使用國際內控自評師名銜第八條國際內控自評師須恪守對內部稽核相關從業人員所訂之職業道德規範 ; 若有違反之情事, 視情節之重大性, 提報本協會考試委員會決議予以懲處或註銷其證書第九條本辦法經本協會理事會審議通過後實施, 修訂時亦同

2 敬啟者 : 通過國際內控自評師考試領有及格證明文件者, 請依照本協會於網頁上刊載之國際內控自評師 (CCSA) 授證及專業名銜使用辦法規定, 填寫下列申請表並備齊相關資格與工作經驗證明文件, 以掛號寄回本協會, 始得申請國際內控自評師證書, 謝謝中華民國內部稽核協會謹啟地址 :10597 台北市南京東路 5 段 16 號 5 樓電話 : 傳真 : 國際內控自評師 (CCSA) 證書申請表中文姓名 : 應考憑證號碼 : 申請證書類別 ( 請勾選 ): 申請國際證書 (NT$500) 申請國際證書及中文證明書 (NT$700) 工作經驗說明 :( 請敘明實質之工作內容 ) 我同意遵守國際內部稽核協會 ( 簡稱 IIA) 之職業道德規範, 若有違反將送至 IIA 全球道德委員會懲處 ( 請至本協會網站, 點選 " 專業指引 / 執業準則 / 職業道德規範 " 之專區查閱 IIA 之職業道德規範, 若您同意遵守本規範, 再於以下欄位以正楷簽名, 正式提出申請 ) 簽名 : 申請日期 : 民國年月日郵寄申請證書時, 敬請確認已附齊以下資料 : 一個人基本資料表 ( 請登入本協會網站證照考試中心列印此資料表, 並請務必確認您的通訊資料是否正確, 若造成證書遺失或誤送, 敬請自行負責 ) 二一年 ( 含 ) 以上內部控制相關工作經驗證明, 例如 : 內控自評稽核品質保證風險管理或環境稽核等, 並以英文填寫經驗驗證表 (Experience Verification Form) 三國際內控自評師審核 ( 經驗或訓練 ) 表 : 請檢附具有七小時以上推動內控自評之實務經驗證明文件, 或符合規定之訓練課程證明文件, 並以英文填寫 CCSA Facilitation experience and/or training Form 四報考時尚未檢附新制之品格推薦表 (Character Reference Form), 請以英文填寫此份表五此份證書申請表六國際證書申請費 : 新台幣伍佰元若您另外需要中文證明書, 請再額外支付工本費新台幣貳佰元 ( 郵政劃撥帳號為 , 戶名 : 中華民國內部稽核協會, 請記得於通訊欄上註明匯款用途說明 : 1. 請寄出本證書申請表前, 請先登入總會 CCMS 系統確認您的正式考試成績, 及四年及格有效期限之時效, 並再次確認您所繳驗之文件是否齊全, 以免因此而延誤證書之申請時程, 謝謝您的配合 2. 所提之工作經驗證明若為在職證明, 須繳交正本, 若為離職證明, 可繳交影本, 且可累計工作經驗年份, 不限為同一機構 3. 國際證書係由美國 IIA 總會於每季分批印製, 耗費時間較長, 敬請耐心等候本協會通知

3 Experience Verification Form Candidate s Name (Please Print): (Last Name) (First Name) (Middle Initial) Candidate s ID Number: The individual named above has applied to the following certification program (check one) and must submit a completed, verified copy of this form in order to complete the experience requirement, as outlined below: CIA (Certified Internal Auditor) 24 months of internal audit experience or its equivalent (defined as experience in audit/assessment disciplines, including external auditing, quality assurance, compliance, and internal control). Please check here if you have submitted a Master s degree. CCSA (Certification in Control Self-Assessment) 12 months of control-related business experience, such as CSA, auditing, quality assurance, risk management, or environmental auditing. CFSA (Certified Financial Services Auditor) 24 months of audit experience in a financial services environment. CGAP (Certified Government Auditing Professional) 24 months of auditing experience in a government environment (federal, state/provincial, local, quasi-governmental areas, authority/crown corporation). CRMA (Certification Risk Management Assurance) 24 months of auditing experience or controls related business experience such as risk management and quality assurance. Professors: Two years of teaching experience in a related topic will be accepted as the equivalent of one year of work experience. If teaching experience is being verified, list course titles, dates, and description of courses. Please complete the following section with experience information. Please use additional forms if needed. Name of Organization: Title: Type of Industry: Government Financial Services Other Dates (Month/Day/Year) From: / / To: / / currently in this position Check job duties: internal audit quality assurance risk management audit/assessment disciplines compliance external auditing internal control Other: Name of Organization: Title: Type of Industry: Government Financial Services Other Dates (Month/Day/Year) From: / / To: / / currently in this position Check job duties: internal audit quality assurance risk management audit/assessment disciplines compliance external auditing internal control Other: Information About Verifier I am (check all that apply): A CIA A CCSA A CGAP A CFSA A CRMA The candidate s supervisor (current or prior) Name (please print): Title/Position: Organization: Address: Phone: Fax: I verify that the candidate named on this form has completed the experience as listed above, and I attest that this experience meets the experience requirement of the program to which the candidate is applying, as outlined above. Verifier s Signature: Date: Please upload the completed form through the document upload portal. Access the document upload portal by going to and clicking the link for the document upload portal. This document will be reviewed within approximately five business days of receipt at The IIA. You may confirm that the document has been approved by going to www. globaliia.org/certification, logging in to your record on the Certification Candidate Management System (CCMS), and clicking on the appropriate certification program on the Certification Progress screen. If the document cannot be approved, you will be contacted. 30

4 CCSA Facilitation experience and/or training Form CCSA candidates must present proof of either facilitation experience OR training. This facilitation requirement does not need to be met before taking the CCSA exam but must be met before becoming certified as a CCSA. This form is not required for the CIA, CFSA, CGAP, or CRMA programs. Validation of Facilitation Experience and/or Facilitation Training for CCSA Candidate This form or a photocopy of this form should be used to verify attainment of appropriate CSA facilitation experience by a CCSA candidate. The following information should be completed and verified by an individual with an IIA certification or the candidate s supervisor. Candidate s ID Number: Last Name: First Name: Middle Initial: Candidate s Organization: EXPERIENCE VALIDATION TRAINING AND/OR FACILITATION VALIDATION TRAINING Information About Verifier I am (check all that apply): A CIA (Certified Internal Auditor) A CCSA (Certification in Control Self-Assessment) A CFSA (Certified Financial Services Auditor) A CGAP (Certified Government Auditing Professional) A CRMA (Certified Risk Management Assurance) The candidate s supervisor (current or prior) Other* (explain): Name (please print): Title/Position: Organization: Address: Phone: Fax: * Other qualified verifiers will be considered for approval. (An example of other qualified verifiers would be the candidate s contractual clients if CSA is performed by a candidate who is an external consultant.) Training Criteria Appropriate courses must include all of the following: Facilitation techniques, including methods to encourage participation, probe for information, and keep discussions on topic. Conflict-resolution techniques, including techniques for handling difficult participant types. Consensus-building techniques. Group dynamics and/or group decision-making. Workshop planning. Facilitation exercise, including group assessment/feedback to participant. Training Attended Name of Course: Basic Course Description: Course Provider: Name of Instructor(s): Course Date(s): Total Time (Hours) in Course (Minimum 14 hours): I verify that the information provided above is correct and that the submitted course meets the criteria listed above for appropriate courses. Candidate s Signature: Date: Required Information Please attach proof of course completion. If the course is not one of the courses pre-approved by The IIA, please attach a course description and/or agenda along with contact information for the course provider. (See and select training and events for a list of pre-approved courses.) I verify that the candidate named on this form has satisfied all of the following requirements: Facilitated or co-facilitated at least one (1) control self-assessment (CSA) workshop, acquiring at least seven (7) total hours of direct facilitation or co-facilitation experience. A CSA workshop is one that assesses and evaluates risks, controls, or processes supporting the achievement of objectives. Demonstrated, through facilitation or co-facilitation, the ability to encourage group participation, resolve conflict (if applicable), and build consensus. Been involved in the planning of at least one (1) CSA workshop. Received assessment/feedback on performance as a facilitator or co-facilitator. Verifier s Signature: Date: Please upload the completed form through the document upload portal. Access the document upload portal by going to and clicking the link for the document upload portal. This document will be reviewed within approximately five business days of receipt at The IIA. You may confirm that the document has been approved by going to org/certification, logging in to your record on the Certification Candidate Management System (CCMS), and clicking on the CCSA certification program on the Certification Progress screen. If the document cannot be approved, you will be contacted. 29

5 Character Reference Form Note to Recommender The individual named below has applied to one of the certification programs administered by The Institute of Internal Auditors. In considering the candidate s qualifications for any of our certifications, we require a character reference evaluation by an individual with an IIA certification, the candidate s supervisor, or the candidate s professor. The basis for this evaluation is the Code of Ethics established by The IIA. Please read the Code of Ethics and then complete and sign this form. The Code of Ethics is available at Candidate s ID Number: Candidate s Name (please print): (Last Name) (First Name) (Middle Initial) Candidate s Organization: Information About Recommender I am (check all that apply): A CIA (Certified Internal Auditor) A CCSA (Certification in Control Self-Assessment) A CFSA (Certified Financial Services Auditor) A CGAP (Certified Government Auditing Professional) A CRMA (Certification in Risk Management Assurance) The candidate s professor The candidate s supervisor (current or prior) Name (please print): Title/Position: Organization: Address: Phone: Fax: Statement of Character Reference In my opinion, the candidate named on this form exhibits high moral and professional character and meets the qualifications set forth by the Code of Ethics established by The Institute of Internal Auditors. Recommender s Signature: Date: Please upload the completed form through the document upload portal. Access the document upload portal by going to and clicking the link for the document upload portal. This document will be reviewed within approximately five business days of receipt at The IIA. You may confirm that the document has been approved by going to logging in to your record on the Certification Candidate Management System (CCMS), and clicking on the appropriate certification program on the Certification Progress screen. If the document cannot be approved, you will be contacted. 27

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