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

As a merit badge counselor, I agree to

Follow the requirements of the merit badge, making no deletions or additions, ensuring that the advancement 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.

List merit badge subjects here.	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.
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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 ___________________
No. 34405
1994 Printing

See also