Merit Badge Counselor Information Sheet - Longs Peak Council
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2Longs Peak Council
Boy Scouts of America
MERIT BADGE COUNSELOR INFORMATION SHEET
(ALL NEW Merit Badge Counselors must attach a BSA Adult Application with
Disclosure Form and a copy of their Youth Protection Training Certificate)
Council: Longs Peak
District:_____________________________________ Troop/Team/Crew Number:__________
Name:__________________________________________________________ Home Phone: _____________________
Address:________________________________________________________ Cell Phone:_______________________
City:______________________________________ State:_____ Zip:_______ Business Phone:____________________
Email:________________________________________
Check One:
I am a new Merit Badge Counselor. I have attached the required BSA Adult Applications
with all the portions completed and all necessary Approval Signatures.
I am currently registered as a Merit Badge Counselor. This is a
Correction
Addition
As a Merit Badge Counselor, I Agree to:
To qualify as a Merit Badge Counselor, you must:
Follow the requirements of the merit badge, making no deletions
Be at least 18 years old (21 for Rifle, Shotgun, and Climbing)
or additions, ensuring that the advancement standards are fair and
Be proficient in the merit badge subject by vocation or avocation
uniform for all Scouts
Be able to work with scout-age boys
Have two or more Scouts or another person present at all
Be registered with the Boy Scouts of America
instructional sessions
Renew my registration annually if I plan to continue as a
Merit Badge Counselor
Is this subject in line
Do you follow this subject as a
If not, do you have any special
with your job,
hobby, having more than a “working
training or other qualifications for
MERIT BADGE(S)
business, or
knowledge” of the requirements in
this subject?
Profession?
the merit badge pamphlet?
If yes, give brief information .
1.
2.
3.
4.
5.
6.
7.
Check One:
□
I wish to work only with _____________
(Unit Numbers)
□
I wish to work with all units the ______________________________________ District(s)
Signature_________________________________________________ Date:______________________
*NOTE: For Rifle Shooting, Shotgun Shooting, and Climbing you must attach a copy of Instructor Certification.
For ALL Aquatic Merit Badges, you must have current Safe Swim Defense & Safety Afloat Training.
Applications without verification of required training will not be processed.
(Merit Badges are listed on the reverse side)
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