Form 512-076-Belated Eagle Scout Rank Application Form - 2016

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Belated Eagle Scout Rank Application
To avoid lengthy processing delays, please refer to the Guide to Advancement, “Eagle Scout Board of Review Beyond the 18th Birthday,”
topic, No. 3, before completing this form. It outlines required documentation and the process that must be followed.
Eagle petitioner’s name _________________________________________________________________ Date of birth ____________________________
Council name or headquarter city (current residence) __________________________________________________ Council No. __________________
Phone Nos. _______________________________________________ Email______________________________________________________________
Address ____________________________________________________ City_____________________________ State ______ Zip _________________
Unit type at the time Eagle requirements were completed (check one):
POST Unit No.: ___________
Council name or headquarter city where Eagle requirements were completed ________________________ Year completed ____________________
Evidence of completion must be submitted to the National Advancement Team through the local council where the petitioner currently resides.
Please check any of the following items included with this application:
Original Eagle Scout rank application signed at the time work was completed
Merit badge certificates or “blue cards”
Photo of merit badge sash (because of availability on the Internet, sashes are not accepted as sole proof of merit badges earned)
Rank certificates or cards
Membership card
Signed and dated handbook or Progress Toward Ranks cards
Unit or council records (unit rosters, advancement reports, etc.)
Newspaper articles
Program or photos from Eagle court of honor
Letters from former leaders or individuals substantiating the claim
A statement from the petitioner and corroborating witness(es)
A statement from the Eagle Scout candidate explaining why the rank was not awarded
Other evidence (describe): ___________________________________________________________________________________________________
All statements and letters must include the date and author’s signature. Usually several pieces of evidence are necessary to make a compelling case.
Please provide an explanation of why the Eagle Scout rank was not awarded.
(Use this space or attach a summary. Please limit the summary to 150 words or less.)
The statements provided are true and correct.
Eagle Scout petitioner signature ___________________________________________________
I support and endorse this application but understand a well-documented and compelling case must be made in order for credentials to
be granted.
Scout executive’s signature __________________________________________________Date request submitted______________________________
Send this signed form and all required documents and evidence noted above to the National Advancement Team:
Scan and email to
U.S. Postal Service, UPS, Federal Express, etc.
S272, 1325 W. Walnut Hill Lane, Irving, TX 75038


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