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					                                   INTERNATIONAL CODE COUNCIL
                        APPLICATION FOR ICC EXAM DEVELOPMENT COMMITTEES

                  Exam Development Committees appointed by the Board for International Professional Standards

PART 1: General Information

1.     Name of ICC Committee(s) on which you would like to be a member.
       (See list of Committees on Page 2-Acronym may be used. List in order of preference.)
       a)
       b)
       c)

2.     Applicant Information

Name
Title
Employer
Address
City                                                            State                 Zip+4
Phone                                                           Ext.                   Fax
E-mail


PART II. Background and Experiences

1.     Previous Committee service, including ICC, BOCA, ICBO, SBCCI and other organizations.
        Organization/Committee                                          Dates of Years of Service

       a)
       b)
       c)
       d)

2.     Education beyond high school.
       Name and Location of School            Course of Study           Degree of Certificate            Date of Completion
       a)
       b)
       c)
       d)

3.     Employment History
       Employer                               Type of Work                         Dates of Employment
       a)
       b)
       c)
       d)

4.     State the contributions, certifications or other qualifications you offer toward the success of the
       Committee in which you have an interest. Certification in corresponding committee preferred.




5.     Check all ICC certifications you currently hold.
           □ Residential Building Inspector                            □   Fire Plans Examiner
          □   Residential Electrical Inspector                           □   Certified Fire Marshal
          □   Residential Mechanical Inspector                           □   Disaster Response Inspector
          □   Residential Plumbing Inspector                             □   Permit Technician
          □   Commercial Building Inspector                              □   Building Plans Examiner
          □   Commercial Electrical Inspector                            □   Electrical Plans Examiner
          □   Commercial Mechanical Inspector                            □   Mechanical Plans Examiner
          □   Commercial Plumbing Inspector                              □   Plumbing Plans Examiner
          □   Residential Energy Inspector/Plans Examiner                □   Residential Plans Examiner
          □   Commercial Energy Inspector                                □   Building Inspector
          □   Commercial Energy Plans Examiner                           □   Electrical Inspector
          □   Green Building – Residential Examiner                      □   Mechanical Inspector
          □   Accessibility Inspector/Plans Examiner                     □   Plumbing Inspector
          □   Property Maintenance & Housing Inspector                   □   Residential Combination Inspector
          □   Zoning Inspector                                           □   Commercial Combination Inspector
          □   Coastal & Floodplain Construction Inspector                □   Combination Inspector
          □   Soils Special Inspector                                    □   Combination Plans Examiner
          □   Reinforced Concrete Special Inspector                      □   Certified Building Official
          □   Pre-stressed Concrete Special Inspector                    □   Building Code Official
          □   Structural Masonry Special Inspector                       □   Electrical Code Official
          □   Structural Steel & Welding Special Inspector               □   Fire Code Official
          □   Structural Steel & Bolting Special Inspector               □   Mechanical Code Official
          □   Spray-applied Fireproofing Special Inspector               □   Plumbing Code Official
          □   Fire Inspector I                                           □   Housing Code Official
          □   Fire Inspector II                                          □   Master Code Professional
          □   Portable Fire Extinguisher Technician                      □   Pre-Engineered Kitchen Fire Ext. Technician
          □   Pre-Engineered Industrial Fire Ext. Technician

Boards
BIPS – Board for International Professional Standards

Exam Development Committees
CBO-EDC – Certified Building Officials Exam Development Committee
B-EDC – Building Exam Development Committee
CC-EDC – Coastal Construction Exam Development Committee
DR-EDC – Disaster Response Exam Development Committee
E-EDC – Electrical Exam Development Committee
EC-EDC – Soils Special Inspector Exam Development Committee
GB-EDC – Certified Inspector of Green Building Technologies Exam Development Committee
M-EDC – Mechanical Exam Development Committee
P-EDC – Plumbing Exam Development Committee
AS-EDC – Accessibility Specialist Exam Development Committee
EN-EDC – Energy Exam Development Committee
FS-EDC – Fire Service Exam Development Committee
PF-EDC – Portable Fire Extinguisher Exam Development Committee
PRF-EDC – Pre-Engineered Fire Extinguisher Exam Development Committee
PMH-EDC – Property Maintenance and Housing and Zoning Exam Development Committee
PT-EDC – Permit Technician Exam Development Committee
RPC-EDC – Reinforced and Prestressed Concrete Exam Development Committee
RPE-EDC – Residential Plans Examiner Exam Development Committee
SM-EDC – Structural Masonry Exam Development Committee
SSW-EDC – Structural Steel and Welding Exam Development Committee
UST/AST-EDC – UST/AST Exam Development Committee

Considerable effort, devotion and hard work will be expected of each Committee member. Committee membership carries
an obligation to participate actively in all work of the Committee including the contribution and generation of information,
prompt reply to draft reports and ballots, attendance and participation at Committee meetings and prompt completion of
assigned tasks.

I hereby agree to notify the International Code Council of a change in any of the information provided in this application
including change in employment. I agree to abide by the rules and policies of the International Code Council. I agree that
ICC shall have nonexclusive, royalty-free license to use any material that I may provide to or develop for the Committee. I
attest that all the information provided in this application for committee membership is true and accurate.

Signature _______________________________________________________________ Date___________________
                                                                                     th
     Applications must be received no later than September 6 for appointments
                                                    st
                    which commence on January 1 of the following year.

                                                  Mail Completed Application to
                                                     Certification and Testing
                                                   International Code Council
                                                       900 Montclair Road
                                                     Birmingham, AL 35213

        Phone: (888) 422-7233                       Fax: (205) 599-9897                      E-mail: sparsons@iccsafe.org

				
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posted:12/5/2011
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