Supernova Awards Mentor Information Form - Boy Scouts Of America
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1
2Boy Scouts of America
Supernova Awards Mentor Information
(Please type or print legibly.)
Name* _____________________________________ Primary phone* _______________________
Home
Cell
Work
Address* ___________________________________ Other phone _________________________
Home
Cell
Work
City/state/zip* ________________________________ Other phone _________________________
Home
Cell
Work
Email address* ____________________________________________
I do not have email.
Age ________
District _______________________________ Unit:
Troop
Team
Crew
Ship No. _____ BSA ID ___________
I am not affiliated with a district.
I am not affiliated with a unit.
*Required field.
Primary phone and email address indicate how Scouts should contact you.
To qualify as a Supernova awards mentor, you must
As a Supernova awards mentor, I agree to
• Be at least 21 years old and of good character.
• Follow the requirements of the awards, making no deletions
or additions, ensuring that the advancement standards are fair
• Be registered with the Boy Scouts of America (position code 52).
and uniform for all Scouts.
• Complete Youth Protection training appropriate for the level you
• Have a Scout accompanied by his or her buddy during all
will mentor.
instructional sessions.
• Be recognized as having the skills and education in the award
• Keep my Youth Protection training current.
topics covered and hold any required qualifications and training.
• Renew my registration annually if I plan to continue as a
• Be able to work with Scout-age youth.
Supernova awards mentor.
Supernova Awards
Add (A)
For each award, list qualification(s) that demonstrate your expertise.
(List each award you wish to mentor.)
Drop (D)
Qualifications could include college degrees, formal training certificates,
positions held, and specific life experiences.
1.
Choose
2.
Choose
3.
Choose
4.
Choose
5.
Choose
6.
Choose
7.
Choose
A = Adding a new merit badge that you will counsel to the roster.
D = Removing your name from the roster for this merit badge.
Complete the following:
This is a new application
time to register as a Supernova awards mentor).
Attach this form to the BSA Adult Application, indicating position code 52 (no charge).
This is an update to an existing list of Supernova awards subjects.
I no longer wish to serve as a Supernova awards mentor.
Council Approval:
Youth Protection training date ____________________
(Attach copy of the current certificate.)
Name (print)______________________________
I agree to work with:
Position _________________________________
Pack(s) _________________________________________________
Date ____________________________________
Troop(s) _________________________________________________
Crew(s): _________________________________________________
All Scouts
Mentors are encouraged to be available to work with any Scout in any unit.
I plan to serve as a Supernova awards mentor for this event or outside organization: ___________________________________
Signature _________________________________________________________________ Date ___________________________
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