The applicant has personally appeared before me APPLICANT’S RECORD COUNSELOR’S RECORD

and demonstrated to my satisfaction that he has

met all requirements for the (please print):
Name ________________________________________ Applicant ___________________________________
________________________________________________
Merit badge

________________________________________________ has given me his completed application for the o Troop

Name of counselor
o Team Unit No.
________________________________________________ _____________________________________________ ____________________
Address of counselor
Merit badge o Post
________________________________________________
City ZIP Code
Completed on __________/_________/_________ by __________________________________________
________________________________________________ Merit badge
Telephone No of counselor Date

_____________________________________/_____/_____ _____________________________________________
Signature of counselor Date Completed _________/_________/__________
Signature of counselor Date
Remarks:
Checked and recorded:
_____________________________________________
________________________________________________ Signature of unit leader
Date Initials
Certificate and badge presented: _____________________
Date

Applicant will turn in this portion to his unit NOTE TO BOY SCOUT, VARSITY SCOUT, It is suggested that the counselor keep this
leader for record posting. OR EXPLORER: Retain this copy for your record in case any question is raised later in
permanent records. regard to this award.

APPLICATION FOR
Counselor
Initial

MERIT BADGE Information for Applicant

• A merit badge application can be approved only
Name______________________________________ by a registered merit badge counselor.
Approval

• You must have a buddy with you (Scout buddy

Date of

Address____________________________________
system) at each meeting with the merit badge
City________________________________________
counselor.
is a registered
• Turn in your approved application to your unit
o Boy Scout o Varsity Scout o Explorer leader. You will be awarded the merit badge
Requirement
no and letter

of _______________________________ No._______ emblem and certificate at a suitable occasion.

Troop, team, post, ship

District ______________________________________ Information for Counselor

• Merit badge applications must be signed in
Requirement Date of Counselor

Council______________________________________ ad-vance by the applicant’s unit leader.

Initial

and is qualified to begin working for merit • The Scout must have his buddy (Scout buddy
badge noted on the reverse side. system) in attendance at all instructional sessions.
no and letter Approval

• You may not change any requirement, but you may

__________ ______________________ share your knowledge or experience that will make
Date Signature of Unit Leader the counseling more interesting and valuable.

BOY SCOUTS OF AMERICA

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