This nomination form is confidential. Please do not advise nominee in any way of your action on his/her behalf. We will notify you if the nominee is selected for an award other than the Certificate of Appreciation. All nominees for ALL awards are added to the list for Certificates of Appreciation.
GUIDELINES FROM THE AWARDS COMMITTEE
1. These awards are presented to registed Scouters serving in the territory of Tres Ranchos District, recognizing their noteworthy and outstanding service to youth.
2. A candidate must be a currently registered Scouter in the Cub Scout, Boy Scout, Varsity Scout, or Exploring program, or serve in a District level position, and should be 18 years of age or older. Service to Scouting and other community and youth activities are the primary considerations.
3. Nominees are evaluated entirely by the record you present on the reverse side of this form. Please be careful to not name the nominee or refer to a particular unit in that section of this application. Nomination forms will not be returned.
I am nominating this person for:
District Award of Merit ____
District Plaque____
District Board ____
Full Name of Nominee:________________________________________
Address:________________________________________
Registered with: Pack#_____ Troop#____ Team#_____ Post#____
Registered Postion in Scouting:___________________________
We, the undersigned, are pleased to nominate the above Scouter:
ALL NOMINATIONS MUST BE MAILED OR SUBMITTED BY _________
TO:
Tres Ranchos Nomination Committee
c/o Scott Evans, District Executive
1001 Davis St
San Leandro,CA 94577
FAX: (510) 638-2179
NOMINATION FOR DISTRICT RECOGNITION
TRES RANCHOS DISTRICT
Total years of tenure as ADULT SCOUTER:_________
SCOUTING LEADERSHIP HISTORY (list which Years in each position:i.e.,1988-1990)
____ Den Leader
____ Assistant Dean Leader
____ Webelos Den Leader
____ Asst. Webelos Den Leader
____ Cubmaster
____ Asst Cubmaster
____ Den Leader Coach
____ Tiger Cub Coach (Organizer)
____ Scoutmaster
____ Asst Scoutmaster
____ Varisity Scout Coach
____ Asst Varsity Coach
____ Explorer Advisor (or Skipper)
____ Associate Advisor (or Mate)
____ Chartered Organization Rep
____ Pack Committee Chair
____ Pack Committee Member
____ Troop Committee Chair
____ Troop Committee Member
____ Team Committee Chair
____ Team Committee Member
____ Unit Commissioner
____ Asst District Commissioner
____ Roundtable Staff (Cub Scout)
____ Roundtable Staff (Boy Scout)
____ Other*______________________
____ Other*______________________
____ Other*______________________
* Positions in district/council committees or others not listed.
TRAINING COMPLETED (Please indicate what YEAR completed)
____ Cub Scout Fast Start
____ Boy Scout Fast Start
____ Pow Wow
____ Woodbadge Beads (Boy Scout)
____ Woodbadge Beads (Cub/Trainer
____ Cub Scout Leader Basic
____ Scoutmaster Fundamental
____ Den Leader Coach Seminar
____ Commissioner Basic
____ Train the Trainer
____ Other_____________________
____ Other_____________________
LEADERSHIP AWARDS(Please indicate year)
____ Den Leader Coach
____ Webelos Den Leader Award
____ Den Leader Coach
____ Cubmaster
____ Cub Scouter Award
____ Scouter's Key
____ Scouter's Training Award
____ Commissioner's Award
BSA RECOGNITION (indicate year)
____ District Recognition Board
____ District Placque
____ District Award of Merit
____ Silver Beaver
____ Adult Religious Award
____ District Commissioner's Award
____ Order of the Arrow
( )Ordeal ( ) Brotherhood ( ) Vigil Honor
NOTEWORTHY AND/OR OUTSTANDING SERVICE TO YOUTH:
Please do not use the nominees name or unit number in completing this section. Furnish as much information as possible; (ie. president of church council, chairman of PTA fundraiser, etc.) PLEASE DESCRIBE HERE ANY EXCEPTIONAL DEDICATION TO SCOUTING. ______________________________________________________ ______________________________________________________________ ____________________________________________________________ ______________________________________________________________ ____________________________________________________________ _____________________________________________________________