Request Form For Extension Of Time To Earn Eagle Scout Rank printable pdf download

11.2.0.0 Request for Extension of Time to Earn Eagle Scout Rank

Check if this is for extension of time to earn Quartermaster rank

OR Venturing Summit Award

“If a youth foresees that, due to no fault or choice of his own, he will be unable to complete the Eagle Scout rank requirements

before age 18, he may apply for a limited time extension. These are rarely granted and reserved only for work on Eagle.”

—Guide to Advancement

Before completing this form, please refer to the Guide to Advancement, “Time Extensions,” 9.0.4.0. It outlines the circumstances

under which an extension may be considered, and the process tha

advancement records in the BSA system are up to date before submitting this request.

Candidate’s name _____________________________________________________________ PID No. ________________________

Date __________________ Council name or headquarter city ______________________________ Council No. __________________

Date of birth _________________

__________________ Life board of review date __________________

Current unit membership—choose one:

TROOP

TEAM

CREW

SHIP

Unit No. _____________________

All of the following must be included with this application (Incomplete extension requests will be returned.):

atement

Written statements (or interview summaries) from persons with knowledge of the case

position statement (such as meeting notes, statement from a health professional if applicable, etc.)

All requests, letters, and position statements must include the date and signature of the author or committee chair.

Please provide a brief summary of circumstances preventing completion of requirements prior to 18th birthday.

Use this space or attach a summary. Please limit the summary to 150 words or less.

The council advancement chair and staff advisor are to select at least two council advancement committee members who research

a request for extension. Their names and contact information, along with others requested below must be provided. They may be

contacted as this case is considered.

Position or Relationship

Name

Preferred Phone No.

Email Address

Council advancement chair

Council advancement staff advisor

Council advancement committee member

Unit leader

Parent

I certify the procedures regarding time extensions as outlined in the Guide to Advancement were followed, and based on our council

advancement committee’s research, I recommend the following decision:

Acceptance

No. of months of extension recommended _____________

Denial

Scout executive’s signature _____________________________ Date request submitted ____________________________________

Send this signed form and all required documents and evidence noted above to the National Advancement Team:

Fax

U.S. Postal Service, UPS, Federal Express, etc.

972-580-2430

S272, 1325 W. Walnut Hill Lane, Irving, TX 75038

This form is available for downloading at

512-077

2015 Printing

GUIDE TO ADVANCEMENT | 87

Request Form For Extension Of Time To Earn Eagle Scout Rank

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