HOUSATONIC COUNCIL, B.S.A.
326 Derby Avenue
Derby, CT 06418
Phone #(203) 734-3329
Fax # (203) 734-0222
MERIT BADGE COUNSELOR APPLICATION
(Please type or print) Date_______________________
Name _________________________________ Age ____Email __________________________
Home Phone __________________________________Business Phone ____________________
The following are the qualification and requirements for Merit Badge Counselors:
You must be at least 18 years old.
All merit badge counselors need to take Youth Protection course. The course is located at
You must be proficient in the Merit Badge subject by vocation or avocation.
You must be able to work with Scout age boys.
You must follow all National Merit Badge Counselor policies and procedures.
List below the Merit Badge Subjects you are applying for, adding new or removing.
Indicate your selection(s) by placing an “X”, under the appropriate column(s).
Please write, in detail, your qualifications for each Merit Badge, separately, on the back of this sheet,
unless you are removing it.
Only NEW Merit Badge applicants must submit a BSA Adult Registration Application with this form.
(There is no fee required)
MERIT BADGE PROFESSION HOBBY ADD REMOVE
As a Merit Badge Counselor I agree to:
A. Follow the requirements of the Merit Badge, making no deletions or additions, ensuring that the advancement
standards are fair and uniform for all scouts.
B. Have three or more people (another scout, a parent, a leader, or another adult supervisor) present at all sessions.
Signature of Applicant Date
Please list three references, Scouters preferred, if you are a NEW applicant Phone #
The Council Advancement Committee reviews applications during our monthly meetings (except July). If you
have been approved to be a counselor, you will be added to the council merit badge list on our website monthly.
This form needs to be filled out completely including qualifications per merit badge.