SCAMPI Lead Appraiser and SCAMPI B&C Team Leader Certification Application Please check the certified role for which this application will be considered: SCAMPI Lead Appraiser for Development SCAMPI Lead Appraiser for Acquisition SCAMPI Lead Appraiser for Services SCAMPI High Maturity Lead Appraiser SCAMPI B&C Team Leader for Development SCAMPI B&C Team Leader for Services SCAMPI B&C Team Leader for Acquisition Please check the certified roles that you currently hold. ☐ SCAMPI Lead Appraiser for Development ☐ SCAMPI Lead Appraiser for Acquisition ☐ SCAMPI Lead Appraiser for Services ☐ SCAMPI High Maturity Lead Appraiser ☐ SCAMPI B&C Team Leader for Development ☐ SCAMPI B&C Team Leader for Services ☐ SCAMPI B&C Team Leader for Acquisition ☐ Introduction to CMMI for Development Instructor ☐ Introduction to CMMI for Services Instructor ☐ CMMI-DEV Level 2 for Practitioners Instructor ☐ CMMI-DEV Level 3 for Practitioners Instructor ☐ Acquisition Supplement for CMMI for Development Instructor ☐ Development Supplement for CMMI for Services Instructor ☐ Services Supplement for CMMI for Development Instructor This application has several sections that must each be completed before the form will be processed: 1. Contact and sponsoring Partner information 2. Information about your education, appraisal experience, domain experience, etc. 3. Commitment to the CMMI Institute Code of Professional Conduct 4. Confirmation of data submission and signature All information and supporting documentation must be in English. Page 1 of 8 1/29/2013 SECTION 1 Contact Information First Name Last Name Preferred Email Address Title (Mr., Mrs., Ms., Dr.) Rank (if applicable) Fax Number Phone Number Preferred Mailing Address City State/Province & Country Postal Code Current Employer Name Employer City Employer State/Province & Country Postal Code Information about your sponsoring organization Sponsoring Partner Organization Street Address Division, Department, or Branch City State/Province & Country Postal Code A Sponsorship form has been submitted by my sponsoring organization Business Point of Contact to the CMMI Institute. Yes ______ No_____ Page 2 of 8 1/29/2013 SECTION 2 Information about your education Provide the following information regarding your attendance in the required courses for your certification program. These requirements are listed on the relevant CMMI Institute Certification pages. Dates Attended Course Title Instructor Location Instructor Location Instructor Location Instructor’s Organization Dates Attended Course Title Instructor’s Organization Dates Attended Course Title Instructor’s Organization Provide the following information regarding your educational background. Candidates must have a Bachelor’s degree in a related technical area (such as systems engineering or software engineering), or equivalent experience. Highest Degree Attained College or University Street Address Dates Attended City State/Province Postal Code Next Highest Degree Attained College or University Street Address Dates Attended City State/Province Postal Code Page 3 of 8 1/29/2013 CMMI Institute Active Certification(s) Sponsoring Organization Street Address City State/Province Postal Code Other Applicable Active Certification(s) Sponsoring Organization Validity Period Street Address City State/Province Postal Code Appraisal and ATM Experience SCAMPI LA and B&C Team Leader Applicants: Provide evidence of having participated as an appraisal team member on at least two SCAMPI A appraisals, or one SCAMPI A appraisal and two SCAMPI B and/or C appraisals. Experience listed must have occurred within the last 24 months and must be on file in the SCAMPI Appraisal System (SAS). High Maturity LA Applicants: Provide evidence of having led at least two CMMI SCAMPI A appraisals and participated as an appraisal team member on at least one High Maturity SCAMPI A appraisal. Experience listed must have occurred within the last 24 months and must be on file in the SCAMPI Appraisal System (SAS). Note: CMM appraisal experience will not be accepted. Dates CL/ML Appraisal # SCAMPI Class Location CL/ML Appraisal # SCAMPI Class Location CL/ML Appraisal # SCAMPI Class Location Appraised Organization Dates Appraised Organization Dates Appraised Organization Page 4 of 8 1/29/2013 Domain Experience Provide evidence of your domain-specific experience as required by your certification program in the space below. These requirements are listed on the relevant CMMI Institute Certification pages. SCAMPI LA and B&C Team Leader Applicants: Provide evidence of training and/or experience in classroom presentation and management skills, including presenting procedural and conceptual information in a clear and concise manner and facilitating group discussion and interaction using instructional media presentation (audio/visual) systems and aids. SCAMPI LA and B&C Team Leader Applicants: Provide evidence of at least 10 years of project management and engineering experience in systems or software. At least two of these 10 years must include management of technical personnel. Page 5 of 8 1/29/2013 High Maturity LA Applicants: Provide evidence of experience working in a high maturity process improvement environment in one of the following two areas: ◦Developing/facilitating high maturity training at an organization ◦Statistical/quantitative management, or modeling & simulation experience in direct support of managing/building products SCAMPI LA for Services Applicants: Provide evidence of at least 10 years of experience as an employee and/or manager/supervisor in a services environment. Three of the 10 years of services experience must be in a non-CMMI environment; at least two of the 10 years must be managing a service. Experience may include volunteer or community service. Page 6 of 8 1/29/2013 SECTION 3 A signed copy of the CMMI Institute Code of Professional Conduct has already been submitted to the CMMI Institute Yes ______ No_____ Code of Professional Conduct Commitment Form for Individuals CMMI Institute Code of Professional Conduct Commitment Form for Individuals All individuals who wish to become authorized or certified must complete this form before being permitted into an advanced training class or before an authorization or certification will be given. If you have any questions, please send email to [email protected]. Last Name (Family Name) ____________________________________________________ First Name _________________________________ Middle Name _________________ Phone Number __________________ Email Address _____________________________ Primary Partner Sponsor Organization _____________________________________ CMMI Institute Product Suites (Please check all that apply) CMMI SCAMPI PCMM Commitment: I am committed to the Code of Professional Conduct for CMMI Institute Services (the Code). I understand that by making this selection, I am agreeing to abide by the Code for all of my current and future CMMI Institute authorizations and/or certifications. I am NOT committed to the Code of Professional Conduct for CMMI Institute Services (the Code). I understand that by making this selection, I am not agreeing to abide by the Code. I further understand that my CMMI Institute authorizations and/or certifications and/or candidacies will be discontinued within 30 days of the submission of this form. Signature ______________________________________ Date ____________________ Page 7 of 8 1/29/2013 SECTION 4 By signing this application: I have read, understand, and accept all the applicable certification policies of the CMMI Institute I have read, understand, and accept the terms and responsibilities outlined in the COPC for Individuals I declare that all the information on all of the pages of this application is true and accurate. I understand that misrepresentations or incorrect information provided can result in disciplinary action(s), including suspension or revocation of my eligibility or credential(s). ______________________________ Signature ______________________________ Date ______________________________ Print Name Please sign and return this form and any supporting documentation to the CMMI Institute by one of the following means: Postal Mail: Certification Program Administrator CMMI Institute 11 Stanwix Street Suite 1150 Pittsburgh, PA 15222 Email: [email protected] Fax: Certification Program Administrator 412.282.4030 Page 8 of 8 1/29/2013
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