Merit Badge Counselor Information Sheet - Boy Scouts Of America
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1OFFICE USE ONLY
BOY SCOUT OF AMERICA
New Merit Badge Counselor
Update Current List for Merit Badge Counselor
MERIT BADGE COUNSELOR
Effective Date: ____________________________
INFORMATION SHEET
_________________________________________
(Please read entire form before completing)
Signature
Date
ALL New Merit Badge Counselors and those that did not renew their Merit Badge Counselor status, must
complete an Adult Application and Disclosure form and turn it in with this Information Sheet. Your Merit Badge
Counselor renewal form will be mailed out mid July and must be returned by August 15 in order for a counselor
to remain active.
Name ________________________________________________________ Business Phone
__________________
Address ______________________________________________________ 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, avocation, or
uniform for all Scouts
special training
•
Have a Scout and his buddy present at all instructional sessions
•
Be able to work with Scout-age boys.
•
•
In order to remain an Active Merit Badge Counselor I will
Be registered with the Boy Scouts of America
renew my Merit Badge Counselor Registration with the renewal
•
Have current Youth Protection Training
form each year by May 15th.
(must be renewed every two years)
August 15th.
IMPORTANT INFORMATION:
If you are applying for Merit Badge Counselor status for the first time you must include an adult application & disclosure form.
(An application is not required if you are currently registered as a MBC and are adding merit badges to your existing list.)
If you are going to be a counselor for Rifle, Shotgun, Scuba or Whitewater, you MUST provide current certification with your application.
If certification is not included you will be notified by your District Advancement Chair and you will not be registered
for that Merit Badge until the certification is received.
Special Training
Vocation
Avocation
If not, do you have any special training, or
Is this subject in line with your job,
Do you follow this subject as a hobby,
other qualifications for this subject? If yes,
business, or profession? If yes, give brief
having more than a “working knowledge” of
give brief information on the reverse side.
information on the reverse side.
the requirements? If yes, give brief
information on the reverse side.
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3.
4.
5.
6.
7.
8.
9.
10.
I am currently registered in ____________ CHECK ONE: I wish to Counsel Scouts in
Troop Only ____________ or
All Units
Unit Number
Unit Number
Signature ___________________________________________________________________________________Date _____________________
Council Approval _____________________________________________________________________________Date _____________________
DATE RECEIVED IN COUNCIL OFFICE: ___________________________
Pub/Reg/Merit Badge Counselors/Merit Badge Counselor Information Sheet 7-1-2013
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