Merit Badge Counselor Application

W.D. Boyce Council BSA

Revised November, 1998

Initial Application: or Recertification: Date:

Name: Age:

Address:

City: State: Zip:

Home Phone: Work Phone:

Email Address:

I authorize my address to be published on the Internet: Yes: No:

Are you currently a BSA Registered Leader: Position: Unit:

Please list the Merit Badges you want to counsel for, and your qualifications.

Include education, training, or Scouting background related to the badge.

Name of Merit Badge	Qualifications
1
2
3
4
5
6
7
8
9
10

I understand that I may be requested to counsel Scouts from all Troops in the CrossRoads District, and that I am NEVER to counsel one on one with a Scout. A third person MUST be present at all sessions.

Applicant’s Signature: Date:

Training Status _____ I need training to become familiar with all the duties of a Merit Badge Counselor. _____ I have received Instructions but have a few questions about being a Counselor _____ I am confident I am qualified to perform the duties of a Merit Badge Counselor

Application Approved by District Advancement Chair: Date:

Applicant: Forward this form and a BSA Adult Leader Registration Application to your district Advancement Chairman (Both forms are required for initial and recertification)

District: Approve, provide training, forward both forms to Council. Copy this form for district

Note: An annual recertification is required each year to run in conjunction with a February month end registration. All counselors must complete a new MB counselor application and a new BSA Adult leader application.

Council: Enter Data from BSA Adult Registration Application after approved by the District Executive