Merit Badge Counselor Information Form

Merit-Badge-Counselor-Information-Form1 Merit-Badge-Counselor-Information-Form1

User Manual: Merit-Badge-Counselor-Information-Form

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Boy Scouts of America

MERIT BADGE COUNSELOR INFORMATION
(Please type or print.)
Name ______________________________ Age ______________ Business phone (___) _______________________
Address ______________________________________________ Home phone (___) __________________________
City ____________________________________________ State _____________ Zip code _____________________
To qualify as a merit badge counselor, you must
• Be at least 18 years old.
• Be proficient in the merit badge subject by vocation, avocation, or
special training.
• Be able to work with Scout-age boys.
• Be registered with the Boy Scouts of America.

As a merit badge counselor, I agree to
• Follow the requirements of the merit badge, making no deletions or additions, ensuring that the advancement standards
are fair and uniform for all Scouts.
• Have a Scout and his buddy present at all instructional sessions.
• Renew my registration annually if I plan to continue as a merit
badge counselor.

Vocation

Avocation

Special training

Is this subject in line with your job,
business, or profession? If yes, give
brief information on the reverse side.

Do you follow this subject as a
hobby, having more than a “working
knowledge” of the requirements? If
yes, give brief information on the
reverse side.

If not, do you have any special
training or other qualifications for
this subject? If yes, give brief information on the reverse side.

List merit badge subjects here.
1. ____________________________________________________________________________________________
2. ____________________________________________________________________________________________
3. ____________________________________________________________________________________________
4. ____________________________________________________________________________________________
5. ____________________________________________________________________________________________
6. ____________________________________________________________________________________________
7. ____________________________________________________________________________________________

CHECK ONE:

■ I wish to work only with ______________________.
Unit number

■ I wish to work with all units.
Signature _____________________________________________________________ Date _____________________
Note: The BSA Adult Registration Application must be attached.
Council approval by _____________________________________________________ Date _____________________
#34405
34405
2001 Boy Scouts of America

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30176 34405

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