Application for Certified Consulting Meteorologist …

                 Application for Certified Consulting Meteorologist




                                                American Meteorological Society
                                        45 Beacon Street, Boston, Massachusetts 02108-3693
                                                   Tel: (617) 227-2426 ext. 215
                                                        Fax: (617) 742-8718
                                                  E-mail: amsprof@ametsoc.org
                                                      http://www.ametsoc.org

                Serving the Atmospheric and Related Oceanic and Hydrologic Sciences Since 1919
___________________________________________________________________________________________________

Please complete this entire application and provide a summary of your record of technical experience on a separate sheet of paper. You
will be required to do the following (except as may be waived at the discretion of the Board of Certified Consulting Meteorologists): (1)
pass a written examination administered by the Board; (2) submit to the Board five copies of a technical report in the field of
meteorology prepared by you or under your direction; (3) and pass an oral examination administered by the Board. Transcripts from
universities and colleges, statements from references and supporting documents are to be submitted to AMS Headquarters, Attn: CCM
Program. Please return this application along with the fee of $300 (AMS Members); $600 (Non-members) to AMS Headquarters, Attn:
CCM Program, 45 Beacon St., Boston, MA 02108-3693.
___________________________________________________________________________________________________

Name _________________________________________________________________________________________________________

Home Address _____________________________________ City ____________________ State ________ Zip Code_______________

Employer (or self-employed) ______________________________________________________________________________________

Address___________________________________________City______________________State________ Zip Code_______________

Contact Information:

Home Phone: _______________________ Office Phone: __________________________ E-mail: ______________________________

My academic record, which I submit in support of my application, is as follows:

 Academic Institution                               Degree               Major                                  Year




I have requested registrars of the above academic institutions to forward transcripts of my records directly to the chairperson of the
Board, c/o CCM Program at AMS Headquarters.

List any additional non-academic accomplishments during your military service (if applicable) or with any other government program
and/or private institution.

 1.
 2.
 3.
 4.
 I am a member of the following technical societies and have the following technical affiliations or distinctions: engineering or scientific
 societies (give grade of membership); honorary, scholastic or technical fraternities; prizes or awards; honorary degrees; engineering
 registration; military or civilian citations for technical achievement, etc.
   1.
   2.
   3.
   4.

 My publications, inclusive of M.S. and Ph.D. dissertations (with full bibliographic citations) pertinent to this application are: - Attach a
 separate sheet to give a further listing of publications.




                                                            TECHNICAL EXPERIENCE RECORD

 On an attached sheet of paper, please submit your record of technical experience. PLEASE BE EXPLICIT as to your duties, character of
 work, its importance, and your degree of responsibility in connection with each engagement. Make statements brief and concise,
 designating each engagement or change in position by a separate letter (ex. a,b,c,...). Include magnitude and complexity of work in which
 engaged, dates of engagement, your duties and degree of responsibility, and the name, title and address of an individual (not deceased)
 familiar with each engagement, preferably the person to whom you reported. Please include whether the engagement is "sub-
 professional" or "professional" work. Please use the following table as a guide.

      1             2                                  3                                            4                              5
             Date                                                                                 Time                 NAME, TITLE AND ADDRESS
Engagement




                             TITLE OF POSITION, NAME OF EMPLOYER AND                      (Years in Decimals to            OF SUPERVISOR
                                 CHARACTER OF EACH ENGAGEMENT                                    Tenths)
             From
                                                                                          (A)              (B)
                                                                                         Sub-
                        To                                                            Professional    Professional
                                                                                         Work            Work
      a


 Area(s) of specialization in atmospheric and related oceanic and hydrologic sciences:



 Association or employment with consulting companies or Certified Consulting Meteorologists:




 The following three persons have indicated their willingness to serve as references in support of my application. These persons are in one
 or more of the following capacities and at least one of the three should preferably be a Certified Consulting Meteorologist:

       1. Department head or senior faculty member in the department of major study at the academic institution(s) I have attended.
       2. Official of a client company or institution or agency
       3. A superior in my employing company, institution, or governmental agency.
       4. A Certified Consulting Meteorologist. (See August Bulletin for list.)
       5. A colleague with whom you have had extensive professional collaborations

    Name                                            Title                       Mailing Address
    A)

    B)

    C)
I authorize the chairperson of the Board of Certified Consulting Meteorologists to write directly to the above listed references for a statement concerning
my qualifications. I also understand that the chairperson of the Board has the right to communicate with those persons and organizations, which I have
named in this application in regard to my qualifications for certification.
____________________________________________________________________________________________________________________________

I agree that the granting of the Certificates for Consulting Meteorologists by the American Meteorological Society is made under procedures prescribed by
the Council. I agree that my Certificate, if granted, may be revoked by the Council. I agree to abide by the decisions of the Council in all matters
pertaining to the processing of my application for Certification, granting or denial of the Certification, or revocation of the Certificate if those bodies
acting in due authority so decide that action is advisable. I hereby waive any right I may have by existing or future law, federal of state, to file suit against,
recover damages, or recover court costs from the American Meteorological Society, the Board of Certified Consulting Meteorologists, or any member of a
Board, Commission, or Council of the American Meteorological Society, in connection with my application for certification, the certification procedures,
or renewal or revocation of Certification.

It is my understanding that my non-refundable application fee is to be applied to the expenses in processing my application and that this fee will be paid to
the American Meteorological Society on receipt of the application. Certification is granted for a period of one year and is renewed annually. Renewals are
billed by the American Meteorological Society in conjunction with annual membership and subscription notices. Finally, I understand that this
professional certification program is a service offered by the American Meteorological Society in accordance with its constitution and by-laws.

I certify that the information I have furnished above is complete and accurate. I agree to support the objectives of the Society and to abide by Article XII -
Guidelines of Professional Conduct - of the Constitution of the American Meteorological Society.

I agree to not enter into any technical consultation with a CCM Board member at any point in the process, prior to the conduct of the oral examination.
Should it be determined that such consultation has taken place, the CCM Board reserves the right to deny oral examination.



Date: _____________________________ Signed: ___________________________________________________________________________________