Merit Badge Counselor Application Form

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Rip Van Winkle Council
Boy Scouts of America
Merit Badge Counselor Application
Please print or type.
Date of Birth _______________
Name ______________________________________________
Phone _____________________
Scouts will use
Address ________________________________ Apt # ______
e-mail _____________________
City _______________________________ State ___________
Zip ___________- ___________
Currently registered with Pack
Crew ______________
Position ___________________
Please Indicate Which Badges and Qualifications on Reverse
To qualify as a merit badge counselor, you must:
• Be at least 18 years old
• Be proficient in the merit badge subject by vocation or avocation (provide certification as needed)
• Be able to work with Scout-age boys (11 to 18 years old)
• Be registered with the Boy Scouts of America as a Merit Badge Counselor (if not currently
registered as MBC, submit an adult application with this form).
As a merit badge counselor, you agree to:
Follow the requirements of the merit badge, making no deletions or additions, ensuring that the
advancement standards are fair and uniform for all scouts.
Have two or more Scouts present at all instructional sessions, or a Scout and his parent present
(No “one-on-one” counseling).
Notify Rip Van Winkle Council directly, if you decide to stop counseling or wish to change the
badges you will counsel. (An annual letter of renewal will be sent in April.)
Signature ___________________________________________ Date ___________________________
Return this form and an adult application
(required as you are now joining on the Council/District level)
Rip Van Winkle Council, BSA
75 Pine Street
Kingston, NY 12401-4937
Upon approval, you will be notified by mail and may then begin to counsel. We suggest you obtain a
copy of the merit badge pamphlet for each subject you are approved for and have it available when
counseling. Merit Badge books are available for purchase at the Council Service Center, located at 75
Pine Street in Kingston (845) 339-0846.
For Scout Office Use Only
Application Received By _______________________________________________________
Date __________________
Certified By __________________________________________________________________
Date __________________
MBC# _________________ Posted ___________________ Advised ___________________ Dropped ___________________


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