Merit Badge Counselor Information Form

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Boy Scouts of America
MERIT BADGE COUNSELOR INFORMATION
(Please type or print.)
Name ______________________________ Age ______________ Business phone (___) _______________________
Address ______________________________________________ Home phone (___) __________________________
City ____________________________________________ State _____________ Zip code _____________________
To qualify as a merit badge counselor, you must
As a merit badge counselor, I agree to
• Be at least 18 years old.
• Follow the requirements of the merit badge, making no dele-
• Be proficient in the merit badge subject by vocation, avocation, or
tions or additions, ensuring that the advancement standards
special training.
are fair and uniform for all Scouts.
• Be able to work with Scout-age boys.
• Have a Scout and his buddy present at all instructional sessions.
• Be registered with the Boy Scouts of America.
• Renew my registration annually if I plan to continue as a merit
badge counselor.
Avocation
Special training
Vocation
Is this subject in line with your job,
Do you follow this subject as a
If not, do you have any special
business, or profession? If yes, give
hobby, having more than a “working
training or other qualifications for
brief information on the reverse side.
knowledge” of the requirements? If
this subject? If yes, give brief infor-
yes, give brief information on the
mation on the reverse side.
reverse side.
List merit badge subjects here.
____________________________________________________________________________________________
1.
____________________________________________________________________________________________
2.
____________________________________________________________________________________________
3.
____________________________________________________________________________________________
4.
____________________________________________________________________________________________
5.
____________________________________________________________________________________________
6.
____________________________________________________________________________________________
7.
CHECK ONE:
I wish to work only with ______________________.
Unit number
I wish to work with all units.
Signature _____________________________________________________________ Date _____________________
Note: The BSA Adult Registration Application must be attached.
Council approval by _____________________________________________________ Date _____________________
#34405
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34405
2001 Boy Scouts of America
30176 34405
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