Nomination For The Ewing M. Kauffman Adult Eagle Scout Award Form - Boy Scouts Of America
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1
2Heart of America Council
Boy Scouts of America
NOMINATION FOR
THE EWING M. KAUFFMAN ADULT EAGLE SCOUT AWARD
The Heart of America Council of the Boy Scouts of America established this award in 2010 as part of its commemoration
th
of the 100
Anniversary of Scouting in the United States. This award recognizes adult Eagle Scouts who have excelled in
their careers or vocations and have provided exemplary service to their community within the Heart of America Council.
Up to three awards are bestowed annually. (Current members of the [Heart of America Council staff, Board of Directors
1
and]
Nomination Committee are ineligible to receive this award during their term of service.) Additional information
regarding the award selection criteria and nomination process and requirements are contained on the following
page.
Please provide the following information (attach additional pages as needed):
Date of Birth: ___________________________
Candidate Name: ____________________________________
Council and Hometown at time of Eagle Award (if known):
Date of Eagle Scout Award (if known): _________
____________________________________________________
Business Address: ___________________________________
Daytime Phone: ____________________________
___________________________________________________
Evening Phone: ____________________________
Home Address: _______________________________
E-mail: ___________________________________
___________________________________________________
Fax: ______________________________________
Profession/Life’s Work: ______________________________
Degree(s) Earned/Curriculum/Year/Institution(s):
___________________________________________________
___________________________________________
Employment Positions Held: __________________________
Certifications / Licenses: _____________________
___________________________________________________
___________________________________________
___________________________________________________
___________________________________________
Community and Service Positions Held: ________________
Distinctions / Recognitions Received:___________
___________________________________________________
___________________________________________
___________________________________________________
___________________________________________
A copy of the Candidate’s resume or vitae may also be attached.
Name, Title and Address of Nominator: _________________
Daytime Phone: ____________________________
___________________________________________________
Evening Phone: ____________________________
___________________________________________________
E-mail: ___________________________________
___________________________________________________
Fax: ______________________________________
Signature of Nominator:
Date:
RETURN THIS NOMINATION FORM AND SUPPORTING MATERIALS BY MARCH 1 to:
Heart of America Council, Boy Scouts of America
Attn: Kauffman Eagle Scout Award Nomination Committee
10210 Holmes Rd.
Kansas City, MO 64131-4212
Questions or return information: Please contact Leslie Staack at 816-569-4963 or .
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