ECLIPSEEarly Career Leadership Intern Program to Serve Engineering

2015-2016 Application (Due by January 2, 2015)

I. PERSONAL INFORMATIONName: Date:Address (indicate preference): Home Work Street: Street:City/State/Zip: City/State/Zip:Phone (H): Phone (W):Email (H): Email (W):

II. PROFESSIONAL INFORMATIONASME Member Grade: ASME Member No:

Describe Current & Past ASME Activities:

Other Professional Activities:

Areas of Technical Expertise:

Honors & Credentials:

Civic/Volunteer Activities:

Describe any leadership position(s) you’ve held in in the activities listed above:

Employment HistoryList most recent employer first.Employer: Dates: Title: Job Function:

III. EDUCATIONList most recent school first.Institution: Dates Attended: Degree/Year: Major/Thesis:

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IV. INTERNSHIP PREFERENCE Please indicate a preference for the area of ASME you would like to serve, if you have one. If you do not indicate a preference, the Committee on Internship Programs will recommend a match for you based on the information you have provided in this application. Please note that your indication of an area of interest does not guarantee you will be assigned to your preferred area. The committee will evaluate your qualifications carefully and take your preference into consideration during the evaluation and placement process.

Internship Selection (Please select an area of interest for your internship placement, or describe a program or initiative in which you are interested):

□ Board of Governors □ Public Affairs & Outreach □ Standards & Certification

□ ASME Foundation □ Technical Events & Content □ VOLT

□ No Preference □ Program or initiative not listed:

V. REQUIRED ATTACHMENTSPERSONAL STATEMENTA statement of no more than 2000 words answering the following questions:

1. Why do you want to become an ECLIPSE Intern?2. How do you envision your experience as an ECLIPSE Intern, now and in the future,

contributing to your work as an ASME volunteer and in your professional career? 3. If you selected an area of preference, please explain your interest in the area you selected for

your internship placement.

LETTER OF REFERENCEA letter of reference from an ASME member who has knowledge of your abilities and interests.

LETTER OF EMPLOYER SUPPORTA statement from your employer indicating time away from your office to attend required program events is supported OR a request that ASME contact the employer to seek such support if you are selected for an internship.

VI. ECLIPSE INTERN PROGRAM COMMITMENTRequirements of participants in the ECLIPSE Intern program include the following:

Attendance at the 2015 Annual Meeting Attendance at the 2015 ASME International Mechanical Engineering Conference and

Exposition, including one-day leadership training Attendance at 2016 Annual Meeting Generate a joint/group 2015-2016 ECLIPSE interns’ white paper on ideas on how ASME can

improve its service to the community, to be completed by the 2016 Annual Meeting Full participation in sector assigned tasks

I hereby agree to attend and complete all assigned tasks if selected for the 2015/2016 ECLIPSE Intern

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program and understand that failure to attend or complete assignments could be cause for program dismissal.Signature: Date:Electronic signature is accepted.

VI. RELEASEI hereby state that the above and attached accompanying information is correct to the best of my knowledge. I give ASME permission to use this information as needed to select ECLIPSE Interns.

Signature: Date:Electronic signature is accepted.

Please title electronic files: First Name Last Name ECLIPSE 2015 Application (i.e. Jane Doe ECLIPSE 2015 Application). It is strongly recommended that you send a single PDF file containing the Application Form and the three attachments requested in Item V. above. If sending separate files, identify by using: First Name, Last Name ECLIPSE 2015 Reference or Personal Statement or Employer Support. Mail or e-mail (preferred). Email subject line should read - ECLIPSE Intern Application.

Email to:bruffc@asme.org

or

Mail to:Clare BruffManager, Volunteer Leadership DevelopmentASMETwo Park AvenueNew York, NY 10016-5990U.S.A.

All applications are due by January 2, 2015NOTE: Selected interns will be notified by January 31, 2015.

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