EAGLE SCOUT RANK APPLICATION

;j'(f:tHEEAGCE~SCOUT APPLICAN'C-riie'i,ifor;;i;;iiOrii;iliitedoiithis"fo"ii;;tiliii,
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p~~r8f)Uyon file in your council's office. P!e~$e antB(l:lfl>/~11iS$in9
records or your unifs records. 8e prep~re¢ to fumish copie.s,ol
fOUnCI! office so that It may be entered -on to your record. NAME ON OFfICIAL REGISTRATION

?~rw'..'l) 101772160 j

CERTIFICATE NAME SOCIAL SECURITY NO.

\John A. Hoffman
I
Dale joined a Boy Scout troop 02101102
1516 Meadow Ln VERIFIED
Street or R F.D Address
Date became a Varsny Scout

Glenview, IL 60025 Date became a Venturer 09101105

City, State. Zip
APPLICATION Date of First Crass Scout board of reviev •... 03119103
(847) 724-4871
Phone (iIlCIi.J(1H;~J area code; Date of Star scout board of review 07129103

Werf:; you a Cub Scout? YES

Troop 0156
T!'Ut)~" Team, Crt~V'.·.or Ship ,,""ereyou a wobeios Scout? YES
Local No.

Old you earn the ,.'\.rrow of LrqhlAward? YES

Glenview, IL
Cit:.,'.~~lale. 7ip Had you completed the fift!! grade upon jt:.w;ing NO

(.',GE"Hf::OUiHf Mt-NT ELiGH-Jl iTY Merit liad~J8s,b3dges of rank. and Eagle Palms may be earned by a reg!!::ilered 80y Scout, Varsity ScouL or Venturer. He may earn these awards until his
t Sth birthday. /\[1,,/ venture- woo achieved the Firm Class ranI<.as a Boy Scout in a troop or varsity Scoul in a team may continue wo,K;ng for U'1€Star. Ltle. and Eagie Scout ranks and Eaute Palms
wlnte lefv:,(er~;d as a Venturer up Io his Hit)) birthday Scouts and venturers who have completed all requirements prior to their f Bth birthday may be reviewed within three months after
ttrat date with no explanation. Fa: boards- of review conducted between three and SIX months after the candidate's 18th birthday, Cl statement t)y an adult explammq the reason for ine delay must be
attH(:~ll'J(j10 thf' ERQI!-JSGO:H Rank Apphcation when it !s submitted to tile Eaqle Scout Service. The Boy Scout Division at the national office must be contacted for procedures to follow if a
boet d of review is to be conducted more than six months after a candtdate:s 18th birthday.

f•••• ;-;cnu! (If Venturer wrlh a !!"j:jy worj, toward rank sovancernent after he is "i 8 years of aqe. Date of B,,'" 10127190
SrH' Advaucernuut Comm~t!ee end Procedures lor details.

HI~OLlIHi::MENr 1. 8t'Oactive in your troop. learn. crew or ship for a period of at least six months after you nave achieved the rank of life scoot. Dale of Life Scout 10/13/04
b.;:X·H d of review

HEOUIRU ...1FN"T2. Dumonslrale that you live by the principles of the SCOU! Oath and Law in your (~a'ly lilfe. Lis! the «ames of individuals .•.•••
ho know you personally and 'J'.Io=;I(J
be w~mng to prov.de a recommencaucn on your behalf

NAME ADDRESS TELEPHONE

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Earn a toter of 21 merit hadges (mcluding 12 required badges). List the month. day, and year the merit badge V:3S earned.
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'0. LIFESAVING

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Htq:;!re.rj t).'Icl!.)i;'; b !l)?'Y be E.mergency Preparedness or Lifesaving
• Paqe 1-
l~eq;;:r('Jd 1)ad~Je 9 may be Cvclinq, Hiking or Swimming
 "NT 4, \'N!1ile a Life Scout, serve actively far period 01 six months in one or more of the tonowmq positions of responsibiuty. List only those positions served after Life board of review date.
Boy Scout troop. P•.~lroileader. assistant senror patrol leader, senior patrol leader , troop guide. Order of the Arrow troop representative, den chief scribe, librarian, quartermaster.
juruor aselstcru Scoutmaster. chaplain aide. instructor, historian. Venture patrol leader
V •.arsny Scout team. Capl<3II"Lcocapta.n. prO{Ju.ml rnanaqer squad teader, tearu secretary, librarian. quartermaster, chaplain aide, instructor, den chief, Orc.ler of the Arrow team representative
Venturing crew/ship President. vice-president, secretary. treasurer. boatswain, boatswain's mate. yeoman. purser, storekeeper

Date of Lite SCOUi

POSITION FROM TO POSITION FROM TO board ot review

( Troop Assistant Senior Patrol ~:ader 06/01105,. MI01l06 10113/04

!-(t;·:(JU!F~f:".VF.NT S VVtllle a IAe Scout, plan, develop, and give leadership to others in a service project helpful to any re!lgious mstituttou, any scnoor, Dr YDUr commun'ty. The project idea must he
approved by your Scoutmaster ann troop committee find by the council or distnct before you start. You must use the Eagle Scout Leadership Service Project Workbook,
No. 13~927, in meeting this requirement.

Date project was completed 04120108

r,
r~COU!Rt~~vlf:NT Attach to ttus apphcauon a statement of your arnbitions and life purpose and a I;st!ng of posmons held in your rehpious institution, school. camp, community, or other orqanizanons,
!.~uring which you oeroonstreteo teeoersrnp skills. tnc'uoe honors and awards recer ved cunnq tbrs service. Take pari in a Scoutmaster conference with your unit leader.

Date conference was !·lelcj 06106108

CE all statements on this application are true ano correct All requirements were completed prior to rn~f 18th birthday.

Stqnature of ;:·'pf-'iicw): TeiePhonelj{1-f-:}~tJ-I c.tf;~ ~__

__ Dale [~'I~-I··;r1t~I~1
Month Day Year

UNlT ;.\PPf,OV/\L (persona! siqnatcres requrred)

'gnd'_iCecfun,tte"der ~ ?~_ _ Telepi10nL~T 7b~X=~l2--_- Date

e]~jzl
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Month Day Year

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--w" 1"· .re oturnt
, ,. conunittee chair J1~
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Date
[~~Jl~fi'I~I~
tv1:),",!!"; D::!y Year

r:~sJ.\ LOCAL C()UNC!L CF.RT :FIC;I\·j10N. ; •.ccordmn to the records or this council, the applicant is <'I reqrslered member of U·1!Sunit anc all dates listed are correct

~:"~Flf"f1 Positlon~._ _ _._. .~. __._.._ __ _ _. _._ .

Date 07102108

I\CTIONS BY EAGLE SCOUT 80ARD OF f~EV![:~V. The applicant appeared before the Eagle Scout board of review on this dale and th~s application was approved.

Review dale [ITf

MOlllh Day
This dale will be used on the Eaqle Scout credentials

Si£J tature 01 board chue-man Siqnalure of council/district board representative Of applicable}

! certify that all procedures, as outlined in Advancement Commutes Policies and Procedures, have been followed. ! approve this application.

Scout Exocuuve ...__. .__ . ._.~._~ ~,~~

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Presentation of the rank may not be made until the Eagle Scout credentials are received by
r EAGLES~bJT SERViCE VAUDATION!
the BSA local council

The National F:'::J~J!e Scout Assocration is a fellowship of men who have achieved the Eagle
SCGut (ani". Mernhership embraces the top achievers of the Boy Scouts of America.
Benefits mcludu a subscription to Eagletler. The journal keeps NES,l\ members informed
on SCOl.ilH·ll~ in 90ner;::iI and Eagi(') Scouting in particular.

Applications art: 8V~lH<·!bk-~

31 your local council service center.

Requfar flve··Yf·lar memberships are $2~). Life memberships are S180.

EDiTiONS OF THIS APPLlCATiOl' PHEVIOUS TO THE 2002 REViStON SHOULD NOT BE USED

5B~7~~8~: 2002 Boy Scou!.;; of America MPage2M 10 9 8 5

 ! J
~';offman ERROR REPORT 02-JUL-08

/I' f'
~() errorsoun d - app I"ication ven'f'Ied- . Obtain signatures and present to board of review

END OF REF'ORT

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