Eagle Scout Rank Application Form Page 2

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REQUIREMENT 4.
While a Life Scout, serve actively in your unit for a period of six
Venturing crew. President, vice president, secretary, historian, den chief, treasurer,
months in one or more of the following positions of responsibility. List only those
guide, quartermaster, chaplain aide, outdoor ethics guide
positions served after Life board of review date.
Sea Scout ship. Boatswain, boatswain’s mate, purser, yeoman, storekeeper, crew
Boy Scout troop. Patrol leader, assistant senior patrol leader, senior patrol leader,
leader, media specialist, specialist, den chief, chaplain aide
troop guide, Order of the Arrow troop representative, den chief, scribe, librarian,
Lone Scout: Leadership responsibility in his school, religious organization, club, or
historian, quartermaster, junior assistant Scoutmaster, chaplain aide, instructor,
elsewhere in his community
Webmaster, outdoor ethics guide
Varsity Scout team. Captain, cocaptain, program manager, squad leader, team
secretary, Order of the Arrow team representative, librarian, historian, quartermaster,
Date of Life Scout
chaplain aide, instructor, den chief, Webmaster, outdoor ethics guide
board of review
Month
Day
Year
_________________________________________________________________
Position
TO
FROM
Month
Day
Year
Month
Day
Year
_________________________________________________________________
Position
TO
FROM
Month
Day
Year
Month
Day
Year
REQUIREMENT 5.
While a Life Scout, plan, develop, and give leadership to others in a service project helpful to any religious institution, any school, or your community. (The
project must benefit an organization other than Boy Scouting.) A project proposal must be approved by the organization benefiting from the effort, your unit leader and unit commit-
tee, and the council or district before you start. You must use the Eagle Scout Service Project Workbook, No. 512-927, in meeting this requirement.
Project name: _____________________________________________________________
Date project finished
Grand total of hours: __________ (from Eagle Scout Service Project Workbook—for statistical purposes only)
Month
Day
Year
REQUIREMENT 6.
While a Life Scout, participate in a unit leader conference.
Date conference was held
Month
Day
Year
CERTIFICATION BY APPLICANT.
On my honor as a Boy Scout, Varsity Scout, Venturer, or Sea Scout, all statements on this application are true and correct.
All requirements, with the exception of my board of review, were completed prior to my 18th birthday.*
In preparation for your board of review, prepare and attach to your Eagle Scout Rank Application a statement of your ambitions and life purpose and a listing of positions
held in your religious institution, school, camp, community, or other organizations, during which you demonstrated leadership skills. Include honors and awards received
during this service.
_______________________________________________
__________________
Signature of applicant
Telephone
Date
Month
Day
Year
* Or the date established by an extension of time granted by the National Council (see the Guide to Advancement, section 9.0.4.0.). The completion
date does not apply to Scouts registered beyond the age of eligibility as provided for in the Guide to Advancement, section 10.0.0.0.
UNIT APPROVAL
(personal signatures required)
_________________________________________
__________________
Date
Signature of unit leader
Telephone
Month
Day
Year
Scoutmaster, Coach, Advisor, or Skipper
____________________________________________
__________________
Signature of unit committee chair
Telephone
Date
Month
Day
Year
BSA LOCAL COUNCIL VERIFICATION.
According to the records of this council, the applicant is a registered member of this unit and this application is approved
as accurate.
_________________________________________
_________________________________
Signed
Position
Date
Month
Day
Year
REQUIREMENT 7.
Successfully complete an Eagle Scout board of review.
Date
The applicant appeared before the Eagle Scout board of review on this date, and this application was approved.
Month
Day
Year
______________________________________________
______________________________________________
Signature of Eagle Scout board of review chair
Signature of council/district board representative (if applicable)
I certify that all procedures, as outlined in the Guide to Advancement, have been followed. I approve this application.
___________________________________________________________________________________
Scout executive
Date
Month
Day
Year
Presentation of the rank may not be made until the Eagle Scout credentials are received by the BSA local council.
NATIONAL EAGLE SCOUT ASSOCIATION.
As an Eagle Scout, you may now join the National Eagle Scout Association, a fellowship of the top
achievers of the Boy Scouts of America. Each Eagle Scout who applies for membership within six months of his board of review receives a $15
discount off the regular five-year membership fee. Join TODAY at
NESA membership fees go toward the production of the award-winning quarterly Eagle's Call, networking opportunities for Eagle Scouts, and
support of NESA’s many programs such as providing college scholarships.
Lifetime NESA members are eligible to purchase the NESA life member square knot at their local Scout shops. It is the same as the Eagle Scout knot,
but with a silver border, and it replaces the Eagle square knot on the uniform.
Please use the most current application found at
512-728
April 2017 Printing

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