Application For Merit Badge Form
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1
2The applicant has personally appeared before me
APPLICANT’S RECORD
COUNSELOR’S RECORD
and demonstrated to my satisfaction that he has met
all requirements for the (please print):
Applicant ___________________________________
Name ________________________________________
________________________________________________
Merit Badge
o
has given me his completed application for the
________________________________________________
Troop
Name of Counselor
o
Team
Unit number: ____________________
________________________________________________
_____________________________________________
o
Address of Counselor
Crew/Ship
Merit Badge
________________________________________________
City
ZIP Code
__________________________________________
Completed on __________/_________/_________ by
Merit Badge
________________________________________________
Telephone number of Counselor
_____________________________________________
_____________________________________/_____/_____
Date Completed _________/_________/__________
Signature of Counselor
Signature of counselor
Date
Remarks:
Checked and recorded:
_____________________________________________
________________________________________________
Signature of unit leader
Date
Initials
Certificate and badge presented: _____________________
Date
Applicant will turn in this portion to his unit
It is suggested that the counselor keep this record
NOTE TO BOY SCOUT, VARSITY SCOUT, SEA SCOUT,
leader for record posting.
for at least 1 year in case any question is raised
OR VENTURER: Retain this copy for your permanent
later in regard to this award.
records.
The applicant has personally appeared before me
APPLICANT’S RECORD
COUNSELOR’S RECORD
and demonstrated to my satisfaction that he has met
all requirements for the (please print):
Applicant ___________________________________
Name ________________________________________
________________________________________________
Merit Badge
o
has given me his completed application for the
Troop
________________________________________________
Name of Counselor
o
Team
Unit number: ____________________
________________________________________________
_____________________________________________
o
Crew/Ship
Address of Counselor
Merit Badge
________________________________________________
City
ZIP Code
__________________________________________
Completed on __________/_________/_________ by
Merit Badge
________________________________________________
Telephone number of Counselor
_____________________________________________
_____________________________________/_____/_____
Date Completed _________/_________/__________
Signature of Counselor
Signature of counselor
Date
Remarks:
Checked and recorded:
_____________________________________________
Signature of unit leader
________________________________________________
Date
Initials
Certificate and badge presented: _____________________
Date
It is suggested that the counselor keep this record
Applicant will turn in this portion to his unit
NOTE TO BOY SCOUT, VARSITY SCOUT, SEA SCOUT,
leader for record posting.
for at least 1 year in case any question is raised
OR VENTURER: Retain this copy for your permanent
later in regard to this award.
records.
The applicant has personally appeared before me
APPLICANT’S RECORD
COUNSELOR’S RECORD
and demonstrated to my satisfaction that he has met
all requirements for the (please print):
Applicant ___________________________________
Name ________________________________________
________________________________________________
Merit Badge
o
has given me his completed application for the
Troop
________________________________________________
Name of Counselor
o
Team
Unit number: ____________________
________________________________________________
_____________________________________________
o
Crew/Ship
Address of Counselor
Merit Badge
________________________________________________
City
ZIP Code
__________________________________________
Completed on __________/_________/_________ by
Merit Badge
________________________________________________
Telephone number of Counselor
_____________________________________________
_____________________________________/_____/_____
Date Completed _________/_________/__________
Signature of Counselor
Signature of counselor
Date
Remarks:
Checked and recorded:
_____________________________________________
Signature of unit leader
________________________________________________
Date
Initials
Certificate and badge presented: _____________________
Date
Applicant will turn in this portion to his unit
It is suggested that the counselor keep this record
NOTE TO BOY SCOUT, VARSITY SCOUT, SEA SCOUT.
leader for record posting.
for at least 1 year in case any question is raised
OR VENTURER: Retain this copy for your permanent
later in regard to this award.
records.
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