Merit Badge Counselor Information Form Page 2
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1
2National Capital Area Council
Name: ________________________________
PID #:_____________________
E-Mail: ________________________________
Date of Birth:________________
Please list your qualifications for each merit badge you wish to counsel:
Merit Badge
Qualifications
District Advancement Committee Approval __________________________ Date________
District Name ____________________________ District #___________ Council________________
Processing this Application:
Merit Badge Counselors MUST register as adult Scouters and be approved by the District Executive. A new Merit
Badge Counselor does not have to pay a registration fee, but must completely fill out a new Adult Application/
Disclosure Authorization Form indicating a Code 42 and this Merit Badge Counselor Information form (both pages).
Both forms
MUST be submitted to the Troop Advancement Chair if associated with a Troop
or District Merit Badge Dean if applying through District.
The District Merit Badge Dean reviews and approves/disapproves the Merit Badge Counselor Information form
and forwards the Adult Application
to the District Executive (as appropriate).
The District Executive will review and approve/disapprove the Adult Application and forward everything to NCAC (as
appropriate). The Scout Executive approves/disapproves the Adult Application and updates ScoutNet (as appropriate).
FORMS WILL NOT BE PROCESSED IF SENT DIRECTLY TO THE COUNCIL SERVICE CENTER.
All Merit Badge Counselors MUST complete BSA Youth Protection Training before working with Scouts.
All Merit Badge Counselors MUST confirm their registration annually. Any changes must be documented using
this form. An Adult Application, including the Disclosure Authorization, is only required when registering as a Merit
Badge Counselor for the first time or after letting their registration lapse.
Scouters may choose to limit their role to counseling only in an affiliated unit or make themselves available to other units
in the District. NCAC encourages you to be available to other units since the expertise for some merit badges is not
present within many individual units. Counselors will always be able to limit the number of scouts they work with at one
time. Please remember to check the box on the front of this form that indicates this choice.
Page 2 of 2
May 2012
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