Merit Badge Counselor Information Form - Boy Scouts Of America


Boy Scouts of America
(Please print)
Name_______________________________________ Birth Date _________
Business Phone (____) ________________________
Home Phone (____)_________________________
City_____________________________ State_____ Zip Code ___________
E-mail Address _____________________________
To qualify as a merit badge counselor, you must:
As a merit badge counselor, I agree to:
Be at least 18 years old
Follow the requirements of the merit badge, making no deletions
or additions, ensuring that the advancement standards are fair and
Be proficient in the merit badge subject by vocation
uniform for all Scouts.
or avocation.
Have another Scout, parent or guardian, relative or friend present
Be able to work with Scout-age boys
at all instructional sessions.
Be registered with the Boy Scouts of America as a
Renew my registration annually if I plan to continue as a merit
merit badge counselor (position code 42)
badge counselor (position code 42) as required by your district.
Is the merit badge subject related to your work? If the merit badge subject is a hobby, do you have a "working knowledge" of the
requirements? Do you have any special training or other qualifications for the merit badge subject? Explain your qualifications
(For the Swimming and Lifesaving merit badges, current Safe Swim Defense and CPR certification is required. For the Rowing, Canoeing, Small-boat
Sailing, Motorboating and Waterskiing merit badges, current Safety Afloat and CPR certification is required. To serve as a counselor for the Rifle or Shotgun Shooting
merit badge, you must have the relevant NRA certification. First Aid Training is highly recommended for aquatics and shooting merit badge counselors. Additional
Please attach copies of all relevant
council-approved training may be required for other merit badge subjects (for example Whitewater merit badge).
certifications. All required certifications must be maintained and copies submitted as they are renewed.
List merit badge subjects here
Qualifications (Attach additional pages if needed)
There is no fee for becoming a merit badge counselor. You need to submit this form and a BSA Adult Leader Application upon initial
I wish to work with all units
I wish to work only with ________________________________________
(Unit Number)
I am currently registered in ________________ of __________________ District as a _______________________________
(Unit Type and number)
(Scouting position)
I am not currently registered. My Adult Registration form is attached.
Note: The BSA Adult Application must be attached if you are registering as a merit badge counselor (position code 42) for the
first time regardless of any other registrations in any other position or if your registration as a counselor is not current.
Applicant Signature____________________________________________________________ Date_____________________
Council approval by____________________________________________________________ Date _____________________
Revised July 2004


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