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1. Personal
First Name
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First name
Last name
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Last name
Daytime phone
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Name of company or organization
Name and Address
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West Virginia
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2. Professional
Professional field
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None Specified
Aerospace engineering
Chemical engineering
Civil engineering - Structural
Civil engineering - Water/Wastewater
Civil engineering - Surface Water
Civil engineering - Solid Waste
Civil engineering - Other
Computer Systems - Hardware
Computer Systems - Software
Electrical engineering
Environmental engineering
Industrial engineering
Materials engineering
Mechanical engineering
Architecture
Education/Teaching
Financial
Fundraising
Healthcare
Marketing
Public Relations
Public Service
Other
Professional (work) field
Other / Specialty area
Profession years
How many years have you worked in that field / profession?
License
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None specified
Professional Engineer (PE)
Engineer in Training (EIT)
Other
Do you have a professional (engineering) license?
License (other)
If other license, please specify.
Project type
What type of projects do you generally work on?
Project roles
What role(s) have you performed in this work?
Engineering interests
Do you have any other engineering interests or work experiences that would be relevant to EWB? (i.e. work in other fields, hobbies, etc)
Nonprofit experience
As part of your professional work experience, have you worked for or with non-profit organizations on engineering type or related projects in developing countries? What type? Where? When? In what role? What scale?
3. Personal Experience
Developing-country experience
Do you have any experience (working, extended travel or living) in a developing country? For example, with the Peace Corps, church projects, travel, family connections etc. When? Where? How long?
Language (1)
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None Specified
American Sign Language (ASL)
Arabic
Chinese (Cantonese)
Chinese (Mandarin)
Czech
Danish
Ehiopia (Amharic)
Farsi / Iranian / Persian
Filipino / Tagalog
French
German
Greek
Hindi
Indonesian
Italian
Japanese
Lithuanian
Nepali
Norwegian
Pakistani (Pushto)
Polish
Portuguese
Punjabi
Russian
Serbian / Croatian / Bosnian / Montenegrin
Slovak
Spanish
Sri Lanka (Sinhala)
Swedish
Thai
Turkish
Urdu
Vietnamese
What language(s) do you speak in addition to English?
Language Level (1)
- None -
None Specified
basic
conversational
fluent
What is the level of your language ability?
Language (2)
- None -
None Specified
American Sign Language (ASL)
Arabic
Chinese (Cantonese)
Chinese (Mandarin)
Czech
Danish
Ehiopia (Amharic)
Farsi / Iranian / Persian
Filipino / Tagalog
French
German
Greek
Hindi
Indonesian
Italian
Japanese
Lithuanian
Nepali
Norwegian
Pakistani (Pushto)
Polish
Portuguese
Punjabi
Russian
Serbian / Croatian / Bosnian / Montenegrin
Slovak
Spanish
Sri Lanka (Sinhala)
Swedish
Thai
Turkish
Urdu
Vietnamese
What language(s) do you speak in addition to English?
Language Level (2)
- None -
None Specified
basic
conversational
fluent
What is the level of your language ability?
Language (3)
- None -
None Specified
American Sign Language (ASL)
Arabic
Chinese (Cantonese)
Chinese (Mandarin)
Czech
Danish
Ehiopia (Amharic)
Farsi / Iranian / Persian
Filipino / Tagalog
French
German
Greek
Hindi
Indonesian
Italian
Japanese
Lithuanian
Nepali
Norwegian
Pakistani (Pushto)
Polish
Portuguese
Punjabi
Russian
Serbian / Croatian / Bosnian / Montenegrin
Slovak
Spanish
Sri Lanka (Sinhala)
Swedish
Thai
Turkish
Urdu
Vietnamese
What language(s) do you speak in addition to English?
Language Level (3)
- None -
None Specified
basic
conversational
fluent
What is the level of your language ability?
Language - Other
What other language do you speak?
Language Level - Other
- None -
None Specified
basic
conversational
fluent
What is the level of your language ability?
Non-engineering skills
Do you have any non-engineering skills that might be useful? (writing, dancing, musical instrument, flying, first aid, etc.)
Fundraising experience
Do you have any fundraising experience? Describe your experience.
Help fundraising
Are you willing to help with fundraising, and how?
Leadership experience
What leadership and/or team experience do you have?
Other experience
What else should we know about you?
4. Project Interests
Time available for projects
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None Specified
3+ hours a week
1-2 hours a week
5-8 hours a month
1-5 hours a month
less than 1 hour a month
How much time do you expect to be able to commit to a project keeping in mind that projects may run for one to two years?
Project lead?
Are you willing to be a project lead?
Project travel?
- None -
None Specified
none
only weekend travel
1 week
1 - 2 weeks
2 weeks - 1 month
1 month +
Are you willing and able to travel as part of your participation on projects, and if so for what length of time?
Regions of interest
In which areas/regions of the world are you most interested in working?
Countries of interest
Do you have specific countries in which you are most interested in working?
5. Student chapter support
Advisor to student chapter?
Are you interested in being a project advisor or mentor to a student chapter? If yes, check one or more roles below, or enter "Other" role.
Project leader for student chapter
Technical advisor to student chapter
Other role for student chapter
6. Want to be part of a planning committee? -- check interests
Projects
Sustainability
Fundraising
Membership
Student chapter communication
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