Merit Badge Counselor Application Form - Boy Scouts Of America
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2Boy Scouts of America
Merit BAdge CounSelor 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 merit badge counselor, you must
As a merit badge counselor, i agree to
• Be at least 18 years old and of good character.
• Follow the requirements of the merit badge, making no
deletions or additions, ensuring that the advancement
• Be registered with the Boy Scouts of America (position code 42).
standards are fair and uniform for all Scouts.
• Complete Youth Protection training.
• Have a Scout accompanied by his buddy during all
• Be recognized as having the skills and education in the merit
instructional sessions.
badge subjects covered and hold any required qualifications
• Keep my Youth Protection training current.
and training as outlined in the Guide to Safe Scouting or the
Guide to Advancement—or use others so qualified.
• Renew my registration annually if I plan to continue as a merit
badge counselor.
• Be able to work with Scout-age boys.
Merit Badges
Add (A)
for each merit badge, list qualification(s) that support your request.
For more than eight merit badges,
drop (d)
Qualifications could include college degrees, formal training certificates,
attach additional sheets.
positions held, and specific life experiences.
1.
2.
3.
4.
5.
6.
7.
8.
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 (first time to register as a merit badge counselor).
Attach this form to the BSA Adult Application, indicating position code 42.
This is an update to an existing list of merit badge subjects.
Council Approval:
I no longer wish to serve as a merit badge counselor.
Name (print)______________________________
Youth Protection training date ____________________
(Attach copy of the current certificate.)
Position _________________________________
I agree to work with:
Date ____________________________________
All Scouts
All Scouts in these districts: _________________________________
Only with Scouts in these units (indicate whether troop, team, or crew): _____________________________________________
Counselors are encouraged to be available to work with any Scout in any unit.
I plan to serve as a merit badge counselor for this event or outside organization: ______________________________________
Signature _________________________________________________________________ Date ___________________________
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