Boy Scouts Of America Merit Badge Counselor Application
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2Boy Scouts of America
MERIT BADGE COUNSELOR INFORMATION
(Please type or print legibly.)
Name* _________________________________________ Primary phone* ___________________________
Home
Cell
Work
Address* _______________________________________ Other phone _____________________________
Home
Cell
Work
City/state/zip* __________________________________ Other phone _____________________________
Home
Cell
Work
Email address* __________________________________________________
I do not have email.
Age __________
District ___________________________________ Unit:
Troop
Team
Crew
Ship No. ______BSA ID _____________
I am not affiliated with a district.
I am not affiliated with a unit.
*Required field.
Primary phone and email address indicate how Scouts should contact you.
To qualify as a merit badge counselor, you must
As a merit badge counselor, I agree to
• Be at least 18 years old and of good character.
• Follow the requirements of the merit badge, making no
deletions or additions, ensuring that the advancement
• Be registered with the Boy Scouts of America (position
standards are fair and uniform for all Scouts.
code 42).
• Have a Scout accompanied by his buddy during all
• Complete Youth Protection training.
instructional sessions.
• Be recognized as having the skills and education in the merit
• Keep my Youth Protection training current.
badge subjects covered and hold any required qualifications
and training as outlined in the Guide to Safe Scouting or the
• Renew my registration annually if I plan to continue as a
Guide to Advancement—or use others so qualified.
merit badge counselor.
• Be able to work with Scout-age boys.
Merit Badges
Add (A)
For each merit badge, list qualification(s) that support your request.
For more than eight merit badges,
Drop (D)
Qualifications could include college degrees, formal training certificates,
attach additional sheets.
positions held, and specific life experiences.
1.
A
2.
3.
4.
5.
6.
7.
8.
A = Adding a new merit badge that you will counsel to the roster.
D = Removing your name from the roster for this merit badge.
Complete the following:
This is a new application (first time to register as a merit badge counselor).
Attach this form to the BSA Adult Application, indicating position code 42.
This is an update to an existing list of merit badge subjects.
Council Approval:
I no longer wish to serve as a merit badge counselor.
Name (print) _________________________________
Youth Protection training date ______________________
(Attach copy of the current certificate.)
Position _____________________________________
I agree to work with:
Date ________________________________________
All Scouts
All Scouts in these districts: ___________________________________
Only with Scouts in these units (indicate whether troop, team, or crew): ________________________________________________
Counselors are encouraged to be available to work with any Scout in any unit.
I plan to serve as a merit badge counselor for this event or outside organization: _______________________________________
Signature ________________________________________________________________________ Date _______________________________
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