ASQ Certified Master Black Belt Portfolio

ASQ CertifiedMaster Black Belt Portfolio

Master BLACK BELTTable of CONTENTSINTRODUCTIONTO ASQ MBB 3BASICREQUIREMENTS4INSTRUCTIONSFOR SUBMITTING 5CONFIDENTIALITYAND ETHICS 6DEFINITION OF A SIXSIGMA BLACK BELTPROJECT7MBB APPLICATION FORM 8CATEGORY 1 (FORM C1) 10CATEGORY 2 (FORM C2) 11MBB PORTFOLIO 12GENERAL INSTRUCTIONS 12BURDEN OF PROOF –EVIDENCE 13TEACHING, COACHING,MENTORING 14OCCUPATIONAL EXPERIENCEAND RESPONSIBILITY 17TECHNICAL EXPERIENCEAND INNOVATION 23PORTFOLIO CHECKLIST 27SIX SIGMAPROJECT AFFIDAVITEXPLANATION PAGE 28SIX SIGMA BLACK BELTPROJECT AFFIDAVIT/VERIFICATION FORM 292 | Master Black Belt | Form expires 12.01.13

IntroductionThe ASQ Master Black Belt (MBB) certification is amark of career excellence and is aimed at individuals whopossess exceptional expertise and knowledge of currentindustry practice. Master Black Belts have outstandingleadership ability, are innovative, and have demonstrateda strong commitment to the practice and advancementof quality and improvement. Obtaining an ASQ MBB isacceptance and recognition from your peers.To become certified as an ASQ MBB, a candidate mustsuccessfully meet all requirements. To be eligible toapply for the MBB examination, a candidate must holda current ASQ Certified Six Sigma Black Belt (CSSBB).In addition, a candidate must have either of the followingexperience levels:1) At least FIVE years of experience in therole of an SSBB or MBB.OR2) Completion of 10 Six Sigma projects.Candidates must be able to meet these minimumeligibility requirements in order to have theirportfolio reviewed.Once a candidate has met the eligibility requirements,the next step in the process is a portfolio review of thecandidate’s body of SSBB or MBB work. This brochureis designed to help the candidate develop that portfolio.When the review panel approves a candidate’s portfolio,the candidate will be eligible to register for and take theMBB examination.The objective of the portfolio review is to assess thedemonstrated skills and ability that candidates use to applySix Sigma methodologies and practices in their everydayindustry or environment. The portfolio review is designedto assess the following key indicators in practice:• Teaching, coaching, mentoring• Occupational experience and responsibility• Technical experience/innovationCandidates must attain a minimum number of points ineach of these sections of the portfolio.The portfolio evaluation process will be conducted by apanel of subject matter experts who are Master Black Beltsthemselves. This panel will operate independently butunder the guidance of ASQ. The panel will have ultimateresponsibility for judging the quality and appropriatenessof the material and evidence presented in the portfolio.Candidates who meet the required minimums for eachsection of the portfolio will receive an approval letter fromthe review panel stating that they are eligible to take theMBB examination. Candidates who do not achieve thenecessary points will receive feedback from the reviewpanel. This feedback will include information aboutwhy the application failed, resubmission requirements,additional evidence requests, etc.It is ASQ’s goal to make this portfolio application andreview process fair, transparent, and user-friendly.Only after successfully completing all requirements and passingthe examination will candidates receive MBB certification.3 | Master Black Belt | Form expires 12.01.13

Basic RequirementsCandidates must have a currentASQ CSSBB certification and meetthe experience levels in either Category1 (C1), or Category 2 (C2), asdescribed below.C1. At least five yearsof experience serving inan SSBB or an MBB roleC2. Completion of10 Six Sigma Black BeltprojectsThe difference between these twoexperience categories is that C1 isfocused more on a time-served aspectthat allows candidates who are activelyserving in the role as an SSBB or MBBto meet the experience requirement. C2,on the other hand, is aimed at candidateswho may not be actively serving in theseroles now but have substantial priorexperience in these roles. C2 is essentiallyfocused on the quantity aspect of acandidate’s experience.Candidates must submit a copy oftheir ASQ CSSBB certification andproof of the experience level they areclaiming. For example, candidates whoclaim C1 experience should submitletters from employers or clientsdescribing and attesting to their roleas an SSBB or MBB for a five-yearperiod. For C2 experience, candidatesshould submit a list and description ofthe 10 Six Sigma projects completedand should include letters fromemployers or clients attesting to theirrole for each project.Correct FormTo SUBMITOn an annual basis, ASQ, in aneffort to improve this document andcontinuously improve the process,will post an updated version of theportfolio that includes an expirationdate on the footer. Please ensure thatyour portfolio application is the latestversion before submitting.Minimum POINTSREQUIREDCandidates must meet the minimumscoring requirement for each of thethree key performance indicators.• Teaching, Coaching,Candidates Mentoring must meet the minimumscoring (10 requirements points minimum) for each of thethree key performance indicators.• Occupational ExperienceCandidates Responsibilitymust provide documentedevidence (6 points support minimum) of the criteriaselected. Examples of acceptableevidence • Technical are listed Experiencein instructions atthe and beginning Innovation of the portfolio section.(5 points minimum)Candidates must provide documentedevidence in support of the criteriaselected. Examples of acceptableevidence are listed in instructions atthe beginning of the portfolio section.Request ForEVIDENCEThe MBB review panel may, in certaincircumstances, request additionalevidence from candidates in supportof their application and in particular,where the portfolio score is slightlyless than the required number ofpoints in one or more indicators. Theprimary purpose of issuing a requestfor evidence is to provide candidateswith one additional opportunity tosubmit an omitted (or substantiated)piece of evidence in support of pointsclaimed. A request for evidence isnot automatic and you should notexpect to receive one. A requestfor evidence is at the discretion ofthe MBB review panel. It is yourresponsibility to submit adequate andobjective evidence in support of eachpoint claimed.Notificationof RESULTYou should allow up to six weeks afterthe portfolio deadline for submissionfor notification of the result of yourportfolio. We appreciate your patienceand understanding of the duration as itpertains to the rigor and quality of thereview process.4 | Master Black Belt | Form expires 12.01.13

Instructions FOR SUBMISSION1. General instructions for thisapplication:• Clearly label your supportingevidence for each point claimed• Provide all informationrequested• Include attachments andsupplementary documentswhere required• Avoid providing duplicateinformation or details in excessof the requirements2. Attach a copy of your currentrésumé with your application3. Attach a copy of your ASQCSSBB certification4. Attach proof of fulfilling Category 1or Category 2 experience levels5. Evidence and/or experience canonly be used to earn points in onearea of the criteria; duplicationbetween criteria is not permitted.6. Evidence must relate to ASQCSSBB Body of Knowledge (BoK)7. Submit either an electronic copy ora hard copy (paper submission) asfollows:NOTE: We encourage all applicants to save time, money, and the environment by submitting their applicationelectronically. E-applications can be processed much more quickly and efficiently, and they offer fewer opportunitiesfor the kinds of handling errors that can occur with paper submissions.(A) LANGUAGEAll submissions must be in English. Documentspresented as evidence that are not in English mustbe presented in their original, untranslated formand also with a translation into English.(B) ELECTRONIC COPYTo submit an electronic application, candidatesshould download the form and complete all ofthe required entries electronically and append allnecessary attachments; i.e., SSBB affidavits, supportingdocumentation, etc. Your name must be clearlyprinted on each page for identification purposes.Presentation Note: We will only accept typedentry versions of a current MBB portfolio PDFapplication. Hand-written formats are notacceptable and will not be reviewed.Send your electronic copy tombb@asq.orgOn receipt of your electronic submission,a confirmation email will be sent to you.(C) HARD COPYFor hard-copy submissions, candidates are requiredto submit a completed application and twoadditional copies. Candidates will still need toelectronically prefill a current MBB portfolio PDFapplication and then print. We will not accepthand-written applications. All necessary attachments(e.g., SSBB affidavits, supporting documentation)should be appended to the application, and theapplicant’s name must be clearly printed on eachpage for identification purposes.Send your completed hard-copy application to:MBB Portfolio Review Panelc/o ASQ Certification600 N. Plankinton Ave.Milwaukee, WI 53203-2914On receipt of your submission, an email or letter ofconfirmation will be sent to you.5 | Master Black Belt | Form expires 12.01.13

ASQ Confidentiality STATEMENTThis purpose of thisconfidentiality statement isto assure all MBB candidatesthat ASQ will protect theirconfidential informationincluding sensitive informationand materials furnished bythe applicant as evidence tosupport their MBB applicationand portfolio review.ASQ understands and agrees that all information is to be considered confidentialand proprietary to the applicant and ASQ shall hold the same in confidence,and shall not use the confidential information other than for the purposes ofits business with the applicant, and shall disclose it only to its portfolio reviewpanel and ASQ employees with a specific need to know. ASQ will not disclose,publish, or otherwise reveal any of the confidential information received fromthe applicant to any other party whatsoever except with the specific prior writtenauthorization of the applicant.ASQ CODE OFETHICSFundamental PrinciplesASQ requires its members and certificationholders to conduct themselves ethically by:I. Being honest and impartial in servingthe public, their employers, customers,and clients.II. Striving to increase the competenceand prestige of the quality profession,andIII. Using their knowledge andskill for the enhancement ofhuman welfare.Members and certification holders arerequired to observe the tenets setforth below:Relations With the PublicArticle 1 – Hold paramount the safety,health, and welfare of the public in theperformance of their professional duties.Relations With Employersand ClientsArticle 2 – Perform services only in theirareas of competence.Article 3 – Continue their professionaldevelopment throughout their careers andprovide opportunities for the professionaland ethical development of others.Article 4 – Act in a professional mannerin dealings with ASQ staff and eachemployer, customer, or client.Article 5 – Act as faithful agents ortrustees and avoid conflicts of interest andthe appearance of conflicts of interest.Relations With PeersArticle 6 – Build their professionalreputation on the merit of their servicesand not compete unfairly with others.Article 7 – Ensure that credit for the work ofothers is given to those to whom it is due.6 | Master Black Belt | Form expires 12.01.13

Six Sigma PROJECTCLARIFICATIONSix Sigma PROJECTThe following information is intended tobe a guide to clarify what ASQ deems anacceptable Six Sigma Black Belt project.Each project submitted will be reviewedand evaluated for suitability by membersof the portfolio review panel who areMaster Black Belts.SIX SIGMA PROJECTDEFINITIONSix Sigma is a method for reducingvariation in manufacturing, service,or other business processes. Six Sigmaprojects measure the cost benefit ofimproving processes that are producingsubstandard products or services.Whether in manufacturing or serviceindustries, such projects quantify theeffect of process changes on delays orrework. The goal of each successful SixSigma project is to produce statisticallysignificant improvements in the targetprocess; over time, multiple Six Sigmaprojects produce virtually defect-freeperformance. The Six Sigma Black Beltproject is one that uses appropriatetools within a Six Sigma approach toproduce breakthrough performanceand real financial benefit to anoperating business or company.The tools are generic. It is the structureof the project and the associated process(improvement model) that distinguisha Black Belt project from othersimilar quality improvement projects.Financial impact as an outcome is also arequirement within a Black Belt projectwhen compared to other projects.The following examples are not allinclusive,but will provide examples ofacceptable and unacceptable projects.EXAMPLES OFPROJECTS THATQUALIFY:• Reduced product defects inmanufacturing• Reduced cycle time for recruitmentin human resources• Reduced invoice processing costs inaccounts payable• Reduced machine setup time inmanufacturingPROJECTS THAT DONOT QUALIFY:• Prepackaged or classroom exercisesthat are mock or simulated projectsthat were previously completedand/or that do not include actualhands-on work by the applicant• Projects that are not associatedwith a real organization or businessunit; projects that have no currentproblem statement or cost benefit• Basic product improvementprojects not associated with processimprovements• Software maintenance or remediationwithout detailed process measurements• Any project without measuredbefore-and-after cost benefits7 | Master Black Belt | Form expires 12.01.13

MBB Application FORM AND CONTACT INFORMATION1. ASQ MEMBER NUMBER(If you are not an ASQ member, enter your last name and first name to maintain identification throughout the file.)2. Name/ADDRESS/CONTACT INFORMATIONMr. ❏ Ms. ❏ Mrs. ❏ Dr. ❏ If other, please specify __________________First Name Middle Initial Last Name .Home Address _ . Apt./Ste.. .City State/Prov. Zip/Postal Code Country.Home Phone (with area code) .Employer/Co. Name Your Title. .Employer Address .City State/Prov. Zip/Postal Code CountryBusiness Phone (with area code) .Fax # .Email Address .3. FeesPlease make checks/money order payable to: ASQPortfolio Review FeeMemberUS$495NonmemberUS$650You must include payment. Do not send cash. ASQ accepts check, money order, bank draft, or credit card.Check No._________________________ [U.S. dollars drawn on a U.S. financial institution]Credit CardCheck one: VISA ❏ Mastercard ❏ AMEX ❏Card No: ____________________________________________Exp. Date _________________Cardholder Name:___________________________________Cardholder Address: ______________________________________________________________________8 | Master Black Belt | Form expires 12.01.13

MBB Application FORM AND CONTACT INFORMATION4. Six Sigma BLACK BELTAND MASTER BLACK BELTEXPERIENCEDate you attained ASQ CSSBB certification. (mm/dd/yy)____________________________How long have you had the role of a Six Sigma Black Belt?(Years/Months) _____________________How many Six Sigma or Black Belt projects have youcompleted during that time? (#) __________________5. Work EXPERIENCE/HISTORY• Attach a copy of your current résumé, with referencesOR• Attach a description of your work history including:- Company name and dates of employment(start-finish)- Position of responsibility and duties- Accomplishments- ReferencesAre you a Master Black Belt in your organization?❏ Yes ❏ NoIf yes, how long have you been in the role of a Master BlackBelt? (Years/Months) _______________6. Six Sigma EXPERIENCE(Please indicate which experience level you are claiming)Category 1) At least five years of experience serving in the role as a SSBB or MBB❏Category 2)Completion of 10 Six Sigma Black Belt projects ❏Please complete only the experience level category form you are claiming –do not complete both forms.9 | Master Black Belt | Form expires 12.01.13

C1Six Sigma BLACK BELTEXPERIENCE/VERIFICATIONIf you have selected Category 1 (i.e., at least five years of experience serving in the role of an SSBB or MBB) as yourexperience level, please complete this section.Date you attained ASQ CSSBB certification (Month/Year)Please attach evidence of at least five years of experience serving in the role as an SSBBor MBB. The following is an example of acceptable evidence.1. Letters from employer or clients detailing the following pertinent information.• Company name, date of employment (start – finish)• Position responsibility and duties• List of Six Sigma Black Belt projects completed• Accomplishments2. Please describe any other experience that shows you have at least five years’ experience as an SSBB/MBB and providedocumentation in support.10 | Master Black Belt | Form expires 12.01.13

C2SIX SIGMA BLACK BELT PROJECTAFFIDAVIT/VERIFICATIONIf you have selected Category 2, i.e., completion of 10 Six Sigma projects serving in the role of an SSBB or MBB,as your experience level, please complete this section.NOTE: You must attach an affidavit in support of each of the 10 completed Six Sigma projects. Affidavit formsare included at the end of the application.LIST ALL 10 SIX SIGMA BLACK BELT PROJECTS1:2:3:4:5:6:7:8:9:10:11 | Master Black Belt | Form expires 12.01.13

MASTER BLACK BELT PORTFOLIO SECTIONGENERAL INSTRUCTIONSTo demonstrate your experience and accomplishments, please describe specifically how you met each criteria, whereapplicable. Documented evidence must be provided in support for each criteria and labeled. If documentation isnot provided, points cannot be awarded. This ensures that the review is fair and attestable.Please adhere to the following steps:STEP 1. Briefly describe how you met the criteria. Include details such as Company name/location Date: Start – completion Project description Materials developed Your specific role Number of people involved and their positions Outcomes planned/achieved Copies of professional certificates, licenses, or advanced degreesSTEP 2. Attach supporting documentation or evidence and Clearly label it by section number (e.g., evidence for 1.1, 1.2, etc.). Check to ensure that it supports the points claimed Check to ensure that it is presented in a readable formatNOTE: The details listed within each subsection are intended to provide examples of the type ofevidence we are seeking. These lists are not all-inclusive and are not exhaustive; other types of evidencecan be provided.12 | Master Black Belt | Form expires 12.01.13

Burden of PROOF – EVIDENCEPlease read the following statement carefully as it describes what is meant by “evidence.” This criterionwill be used by the MBB Panel when assessing whether to award points on each criterion within yourportfolio.“ASQ and the MBB Panel define ‘evidence’ as that which furnishes proof.”The MBB candidate bears the burden of proof for each point sought in support of their applicationand must present sufficient evidence with their application at the time of submission. The burden ofproof must be fulfilled by establishing positive evidence in support of points claimed. The MBB panelwill seek to authenticate such evidence in terms of ownership, authorship, or co-authorship whereapplicable. If the evidence submitted is inadequate or fails to satisfy the burden of proof by addressingthe requirement, the candidate will have failed to establish adequately the burden of proof. This willresult in zero points being awarded.Clause 1:Clause 2:Clause 3:Clause 4:Clause 5:Clause 6:All evidence submitted shall address or cover the ASQ Certified Six Sigma Black Beltor Master Black Belt body of knowledge.All evidence submitted shall authenticate the candidate’s role clearly.All evidence submitted shall be sufficient in completeness.All evidence submitted shall be clearly labeled for each section.All evidence submitted shall be legible and clear in terms of presentation.All evidence submitted shall be supported by employer verification or attestation.13 | Master Black Belt | Form expires 12.01.13

1: TEACHING, COACHING, MENTORINGMinimum required score for Section 1 is 10 pointsCRITERIA TO EARN POINTS1.1. Evidence of developing Six Sigma training modules related to the ASQ CSSBB BoK (1 point per completetraining module developed; 5 points maximum)1.2. Evidence of formally training Black Belts (1 point per course instructed; 5 points maximum)1.3. Evidence of teaching/coaching/mentoring Champions, Executives, etc. (1 point per application by group;5 points maximum)1.1DEVELOPINGTRAINING MODULES Provide detailed evidenceusing examples such as trainingmodules you developed, trainingmethods, delivery systems initiatingor supporting recurring trainingplans, content development, use oftechnology-based training tools, etc. Supporting documentsshould include training modules,workbooks, evaluations, trainingplans, etc. A training module should focuson multiple DMAIC phases andinclude at least two statisticalmodules at Black Belt level andabove. You must provide completeexamples (not just one or two slides). When furnishing PowerPointsas evidence of developing trainingmaterial, it should be clear thatyou are the owner and author ofthis material. You should provideadditional materials such asemployer verification letters insupport of using this as companyproprietary material for trainingBlack Belts. Consultants can obtainorganizational references in supportof the same. Zero points will beawarded if authentication is notclearly established by the candidate.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______14 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 1 is 10 pointsCRITERIA TO EARN POINTS1.2. Evidence of formally training Black Belts (1 point per course instructed; 5 points maximum)1.2FORMALLY TRAININGBLACK BELTS Provide detailed evidence usingexamples such as the company wheretraining was conducted, type oftraining provided, number of coursestaught, number of Black Beltstrained, etc. Supporting documents couldinclude copy of curriculumdeveloped or used, attendancerosters, outcome measures,participant feedback summarydata, etc. The definition of a course isconsidered training in the full ASQCSSBB Body of Knowledge to fiveor more Black Belts.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______15 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 1 is 10 pointsCRITERIA TO EARN POINTS1.3. Evidence of teaching/coaching/mentoring Champions, Executives, etc. (1 point per application by group;5 points maximum)1.3TEACHING/COACHING/MENTORING CHAMPIONS,EXECUTIVES, ETC. Provide detailed evidenceusing examples such as the type ofapproaches used and include detailssuch as subjects taught, method ofproviding coaching or mentoringfor specific types of group audience,duration of course, coaching, ormentoring process, executionmethod, or delivery system used. Supporting documents couldinclude copies of study materialused, training dates and rosters,mentoring notes, curriculum ormethodology used, feedback fromparticipants, letter from employerclearly describing your role andresponsibility, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______Additional Comments for Section 1: Teaching, Coaching, Mentoring16 | Master Black Belt | Form expires 12.01.13

2: OCCUPATIONAL EXPERIENCEAND RESPONSIBILITYMinimum required score for Section 2 is 6 points2.1. Evidence of using Six Sigma for business/processimprovement (1 point per project; 3 points maximum)2.2. Evidence of working in a professional support position(i.e., SSBB, MBB, statistician, etc.) (1 point per yearper position; 3 points maximum)2.3. Evidence of working in a position of leadership(i.e., MBB, project manager, executive sponsor, etc.)(1 point per year per position; 4 points maximum)CRITERIA TO EARN POINTS2.4. Evidence of working as a project deploymentchampion (1 point per project; 4 points maximum)2.5. Evidence of working in corporate level managementor consulting (1 point per year per position; 4 pointsmaximum)2.6. Evidence of leading or facilitating policy deploymentand transformation activities (1 point per set ofactivities presented; 5 points maximum)2.1USING SIX SIGMAFOR BUSINESS/PROCESSIMPROVEMENT Provide detailed evidence usingexamples such as the approachyou used (e.g., critical to quality)and how you applied the approachto realize projected or plannedoutcomes. Supporting documents couldinclude agendas and results, projectproposals, project pipeline, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______17 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 2 is 6 pointsCRITERIA TO EARN POINTS2.2. Evidence of working in a professional support position (i.e., SSBB, MBB, statistician, etc.) (1 point per year perposition; 3 points maximum)2.2PROFESSIONALSUPPORT POSITION Provide detailed evidence usingexamples such as your role (i.e., BB,MBB, quality engineer, reliabilityengineer, etc.) and what supportyou provided. Supporting documents couldinclude: a letter from employer/client detailing your role andresponsibilities, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______18 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 2 is 6 pointsCRITERIA TO EARN POINTS2.3. Evidence of working in a position of leadership (i.e., MBB, project manager, executive sponsor, etc.) (1 point per yearper position; 4 points maximum)2.3POSITION OFLEADERSHIP Provide detailed evidence usingexamples of activities (i.e., strategicplan deployment, cross-functionalachievement, profit and loss (P&L)responsibilities, etc.) in a leadershipposition (i.e., project manager,MBB, champion, executive sponsor,VP, etc.) Supporting documents couldinclude: a letter from employer/client detailing your role andresponsibilities, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______19 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 2 is 6 pointsCRITERIA TO EARN POINTS2.4. Evidence of working as a project deployment champion (1 point per project; 4 points maximum)2.4PROJECTDEPLOYMENTCHAMPION Provide detailed evidenceusing examples such as the scope ofproject, your role, obstacles, etc.,and list project results or outcomesand the impact to the businessorganization. Supporting documents couldinclude project charters, controlplans, balanced scorecards,storyboard, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______20 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 2 is 6 pointsCRITERIA TO EARN POINTS2.5. Evidence of working in corporate level management or consulting (1 point per year per position; 4 points maximum)2.5CORPORATE LEVELMANAGEMENT ORCONSULTING Provide detailed evidence usingexamples such as position, duration,company size, your responsibilities,and any organizational roadblocksor outcomes. Supporting documents couldinclude letters from employer andclients detailing your leadershipresponsibilities, achievements, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______21 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 2 is 6 pointsCRITERIA TO EARN POINTS2.6. Evidence of leading or facilitating policy deployment and transformation activities (1 point per set of activitiespresented; 5 points maximum)2.6LEADING ORFACILITATING POLICYDEPLOYMENT ANDTRANSFORMATIONACTIVITIES Provide detailed evidence usingexamples such as what you did tolead or facilitate policy deploymentactivities, including auditing,developing short- or long-termgoals, annual organizational goals,project pipelines, etc. Supporting documents couldinclude scorecards, Hoshinor quality plans, deploymentroadmaps, storyboard, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______Additional Comments for Section 2: occupational experience AND responsibility22 | Master Black Belt | Form expires 12.01.13

3: TECHNICAL EXPERIENCEAND INNOVATIONMinimum required score for Section 3 is 5 points3.1. Evidence of certifications offered by professionalorganizations (i.e., ASQ, SME, IEEE, PMP, APICS),state licenses* (i.e., PE, CPA), or advanced degrees fromaccredited institutions (1 point per credential; 2 pointsmaximum)3.2. Evidence of using statistical Six Sigma methods,applications, or tools for improving business results(1 point per unit of evidence; 3 points maximum)CRITERIA TO EARN POINTS3.3. Evidence of current, relevant, peer-reviewedpublications, papers, or presentations (1 point perunit; 3 points maximum)3.4. Evidence of applying advanced analytical concepts andapproaches, and process improvement techniques, aspart of a Six Sigma project (1 point per method ortechnique used; 3 points maximum)3.1OTHERCERTIFICATIONS,PROFESSIONALLICENSES, ORADVANCED DEGREES Supporting documents shouldinclude copies of each certification,license, or advanced degree, etc.Note: You will NOT earn points forhaving a CSSBB, as this is a basicrequirement. We will not award pointsfor lower-level credentials, such as,ASQ SSGB, CQPA, CCT, CQI, etc.,or any comparable level credential. *State licenses for advancedprofessional recognitions basedon multiple years of professionalexperience and passing a broadlyaccepted exam, equivalent toProfessional Engineer, CertifiedPublic Accountant; or advanceddegrees of at least a Master’s Degreelevel from accredited institutionsequivalent to major publicinstitutions of the USA.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______23 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 3 is 5 pointsCRITERIA TO EARN POINTS3.2. Evidence of using statistical Six Sigma methods, applications, or tools for improving business results(1 point per unit of evidence; 3 points maximum)3.2EVIDENCE OF USINGSTATISTICAL SIXSIGMA METHODS,APPLICATIONS, ORTOOLS FOR IMPROVINGBUSINESS ANDPROCESS RESULTS Provide detailed evidence usingexamples such as how you used eachtool/method or application (e.g.,DOE, Taguchi, EVOP, MixtureDesigns, GLM, ARIMA, LinearProgramming, CuSum, etc.) toimprove business results. **Youmust show how you used thesemethods to reach conclusion. Supporting documents couldinclude capability analysis, graphicalanalysis, statistical analysis, etc.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______24 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 3 is 5 pointsCRITERIA TO EARN POINTS3.3. Evidence of current, relevant, peer-reviewed publications, papers, or presentations (1 point per unit; 3 points maximum).3.3CURRENT, RELEVANT,PEER-REVIEWEDPUBLICATIONS,PAPERS, ORPRESENTATIONS Provide detailed evidence usingexamples such as where materialswere published or presented (e.g.,contributions to textbooks, chapterswritten, books edited for subjectmatter accuracy, jury-reviewedmaterials, journals, newsletters, etc.). Supporting documents couldinclude photocopies of any of theabove which cite you as the owner,author, or contributor. Presentations must be externalto your current organizationand be presented at the regional,national, or international level. “Current” is defined as no morethan seven years old. “Relevant” is defined as supportsthe ASQ SSBB Body of Knowledge. No points will be awarded forWeb-based publications.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______25 | Master Black Belt | Form expires 12.01.13

Minimum required score for Section 3 is 5 pointsCRITERIA TO EARN POINTS3.4. Evidence of applying advanced analytical concepts and approaches, and process improvement techniques,as part of a Six Sigma project (1 point per method or technique used; 3 points maximum)3.4EVIDENCE OFAPPLYING ADVANCEDANALYTICAL CONCEPTS,APPROACHES, ANDPROCESS IMPROVEMENTTECHNIQUES, AS PARTOF A SIX SIGMA PROJECT Provide detailed evidence usingexamples such as the tools, methods,approaches used (e.g., QFD, suppliermanagement, analytical hierarchyprocess (AHP), kaizen blitz), andhow they were applied. Describeresults achieved (waste reduction,cycle time reduction, increase incustomer satisfaction, revenue lift,capacity lift, financial savings, etc.). Supporting documents shouldinclude full reports showing howthe process was improved and notjust the tool.Name of evidence file(s) you provided ___________________________________________________________ Total points claimed ______Additional Comments for Section 3: technical experience AND INNOVATION26 | Master Black Belt | Form expires 12.01.13

PORTFOLIO CHECKLISTUse this checklist to ensure that you have provided the required material for each claimed point.Failure to provide supporting documents could result in rejection of your application orautomatic fail at cost to you.Current ASQ-CSSBB Certification – (Ensure that you attached a Copy of your Cert)At least 5 years of experience serving in the role as a SSBB or MBB (Ensure you completed form C1)Completion of 10 Six Sigma Black Belt projects (Ensure you completed form C2 and provided 10project affidavits)CriteriaBrief Description ofSupporting Evidence/DocumentsAttached FileName/Label# PointsClaimedSection 1. Teaching, Coaching, Mentoring1.11.21.3Section 2. Occupational Experience & Responsibility2.12.22.32.42.52.6Section 3. Technical Experience/Innovation3.13.23.33.427 | Master Black Belt | Form expires 12.01.13

SIX SIGMA PROJECT AFFIDAVITEXPLANATION PAGE1. Please print name of Six Sigma Black Belt applicant, along with her/his member number.2. List the official name of the Six Sigma Black Belt project, as listed on your Six Sigma charter.3. Explain briefly the problem you needed to be solved and how it related to your organization’sobjectives.4. List the project’s start and completion dates by month and year.5. Please list the Six Sigma tools used. Be specific as to the name of the tool; specify data,measures, and metrics used. Provide as many examples as possible. Do not send any actualcharts, maps, etc.6. Explain briefly how close you came to reaching your goal and list the success of this project.These may include, but are not limited to, financial savings, labor savings, material costs, cycletimereduction, increased customer satisfaction, etc.7. Verification section must include the project champion’s signature and date signed. In addition,please print the name of the project champion and provide job title and company address. Pleaseinclude telephone, fax, and email information for verification purposes.NOTE: If ASQ has any questions or needs to verify any of the information provided in this affidavit, we will contact the project champion.28 | Master Black Belt | Form expires 12.01.13

SIX SIGMA BLACK BELT PROJECTAFFIDAVIT/VERIFICATION FORMEXPLANATION PAGEPoint 7 of this form is NOT fillable as it requires a written signature by the champion/project supervisor. Also, you willneed to create multiple copies to support each Six Sigma project you are using as proof of experience or projects completed.1. Six Sigma Project completed by _________________________________ _________________________(applicant name)(ASQ member number)2. Six Sigma Project Title __________________________________________________________________3. Provide a brief description of the purpose of the project, and how it related to the business objective:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. Six Sigma project start and completion dates (mm/yy) from:______/________ to:_______/_______5. Provide a brief description of hands-on performance in completing the Six Sigma project. Please includespecific examples of tools used, i.e., process maps, metrics (DPU, DPMO, RTY), procedures, charts, etc.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. Provide a brief statement of the benefits achieved by the successful completion of the project, including butnot limited to financial savings, labor, material costs, cycle-time reduction, etc.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7. Verification of completion by project champion:Verification form completed by:______________________________________________________________(project champion’s signature)(date signed)Champion’s name _____________________________________Job title_____________________________Company name __________________________________________________________________________Address_________________________________________________________________________________Champion’s email address___________________________________________________________________Champion’s telephone # _______________________ Champion’s Fax _______________________________29 | Master Black Belt | Form expires 12.01.13