Adult Leader Training Survey by yaosaigeng


									                                     ADULT LEADER TRAINING & AWARDS SURVEY
PLEASE PRINT                           BSA ID #:                                         Date:                                                     District: Salem District
Name (last):                                          (first):                                              (middle):                               (suffix):
Address:                                                                        City:                                                      ST:     Zip:
Telephone (Home):                                                     (Work):                                             (Cell):
e-mail:                                                                Date of Birth
Current Unit Affiliation(s):      Pack:                          Troop:                            Crew:                       Post:                       Team:
Current Registered Position(s):
Current District Position(s):
Current Council Position(s):
Years in Scouting:           Youth:                Adult:                       Are you an Eagle Scout?          Yes:          No:         If yes, when?
Please indicate the most recent date (mm/dd/yyyy) of completion for each training course you have had and award/recognition you have received, sign the bottom of
 page 4 certifying that this information is true to the best of your knowledge and on your honor as a Scouter, and return this form to your District Training Chair or
                                                                            District Registrar.
This form will be used to update and correct the training status / qualifications of adults within the district and to update council records. If you have any questions,
                                                      please contact your District Training Chair or District Registrar.
Code                  Course                         Date          Code         Course                                  Date        Code            Course                         Date
               Cub Scout Leader Training                                           Boy Scout Leader Training                                      Venturing Leader Training
                       Fast Start                                                            Fast Start                                                   Fast Start
CF-1    Den Leader Fast Start                                      SFS    Boy Scout Leader Fast Start                               PFS Venturing Advisor Fast Start
CF-2    Webelos Leader Fast Start                                                         Youth Protection                                             Youth Protection
CF-3    Cubmaster Fast Start                                       Y01    Youth Protection                                          Y02 Youth Protection
CF-4    Pack Committee Fast Start                                                      New Leader Essentials                                        New Leader Essentials
CF-6    Tiger Den Leader Fast Start                                A01     New Leader Essentials                                    A01 New Leader Essentials
                                                                   WA01    This is Scouting                                         WA01 This is Scouting
                   Youth Protection                                              Position Specific- Current Courses                           Position Specific- Current Courses
Y01  Youth Protection                                              S24    Scoutmaster Leader Specific                               P21 Venturing Leader Specific
               New Leader Essentials                               S10    Troop Committee Challenge                                 P30 Sea Scout Leader Special
A01 New Leader Essentials                                          S11    Intro. To Outdoor Leader Skills                           P31 Crew Officer's Seminar
WA01 This is Scouting
             New Cub Leader Orientation                                    Older Boy Scout Leader Training Courses                          Older Venturing Leader Training Courses
CL101 Intro. To Cub Scouting/How We Have Fun                       S21    Scoutmastership Fundamentals (1987-2001)                  P20 Adult Venturing Leader Basic (1998-2001)
 Position Specific- Current Courses (beginning 9-1-2008)           S20    Boy Scout Ldr Basic Training (1979-1988)                  P01 Here’s Venturing (1998-2001)
CL201   Tiger Den Leader Specific                                  S22    Boy Scout Ldr Basic Training (1972-1979)                  P02 Understanding/Protecting Youth (1998-2001)
CL202   Den Leader Specific                                        S23    Boy Scout Ldr Basic Training (1965-1971)                  P03 Leadership & Organization (1998-2001)
CL203   Webelos Den Leader Specific                                S07    Part 1-The Troop Meeting (1987-2001)                      P04 Awards & Recognitions (1998-2001)
CL204   Cubmaster Specific                                         S08    Part 2- Troop Organization (1987-2001)                    P05 Resources & Program Planning (1998-2001)
CL205   Pack Committee Specific                                    S09    Part 3-The Outdoor Program                                Venturing-Related Supplemental Training
CL206   Pack Trainer Specific                                      S01    (1987-2001)
                                                                          Boy Scouting (1979-1988)                                  P50 Powderhorn Training
            Older Cub Leader Training Courses                      S02    The Patrol Method   (1979-1988)                           P91 Sea Badge
C41 Tiger Den Leader Specific                                      S03    Boy Scout Advancement/Growth (1979-1988)
C42 Den Leader Specific                                            S04    Troop Operation and Admin. (1979-1988)                    A90    Wood Badge for the 21 Century
C61 Webelos Den Leader Specific                                    S05    Troop Program Planning (1979-1988)
C40 Cubmaster Specific                                             S06    The Outdoor Program (1979-1988)                           D69    Trainer Development Conference
                                                                               ********Continued on back********
                                                                                                                     Adult Leader Training Survey         2008

Code                 Course                    Date   Code              Course                      Date      Code             Course                        Date
       Older Cub Leader Training Courses, cont.              Boy Scout -Related Supplemental Training                          District Leader Training
C60     Pack Committee Specific                       S32    Troop Youth Leadership Training                  D00    Commissioner Orientation
C62     Pack Trainer Specific                         S33    Junior Leader Training Conference                DFS    District Commissioner Fast Start
C20     Cub Leader Basic Training (1996-2001)         S34    National Junior Leader Instructor Camp           D20    Commissioner Basic Training
C23     Cub Leader Basic Training (1988-1995)         S35    Order of the Arrow Leadership Seminar            D21    CCS: Bachelors
C22     Cub Leader Basic Training (1975-1987)         S50    Leadership Training for Leaders of 11-yr. olds   D22    CCS: Masters
C21     Cub Leader Basic Training (1967-1974)         S60    Outdoor Skills - Camping                         D23    CCS: Doctorate
C08     Tiger Cub Coach Training (1982-2001)          S61    Outdoor Skills - Team Building                   D24    CCS: Roundtable Commissioner
C11    Cub Leader 3-step course, Part 1 (1975-1987)   S62    Outdoor Skills -Climbing/Rappelling              D25    CCS: Advanced Commissioner Training
C12    Cub Leader 3-step course, Part 2 (1975-1987)   S63    Outdoor Skills - Survival                        D10    CS Roundtable Commissioner Basic
C13    Cub Leader 3-step course, Part 3 (1975-1987)   S64    Outdoor Skills - Backpacking                     D11    BS Roundtable Commissioner Basic
C14    Cub Leader Self-Study course (1975-1987)       S65    Outdoor Skills - Cooking                         D30    Commissioner Conference
             Cub Leader Outdoor Training              S66    Outdoor Skills - Aquatics                        D01    CBasic: Why Commissioners
C32    B.A.L.O.O. training                            S67    Unit of Training - Merit Badge Counselor         D02    CBasic: Units-Cmsnr ‘s Top Priority
C33    Outdoor Webelos Leader Skills (OWLS)           S68    Unit of Training – Youth Protection Overview     D03    CBasic: How to Help a Unit
C09    Webelos Den Leader Outdoor (1967-2000)         S69    Unit of Training – Troop Prog. Plan. Kit         D50    Exploring Team Service (1970-1988)
          Cub-Related Supplemental Training           S70    Unit of Training – Boy Scout Advancement         D61    District Committee Workshop
C30    Cub Scout Leader PowWow                        S71    Unit of Training – Effective Teaching            D71    Council Officer/Board Orientation
C31    Den Chief Training                             S72    Unit of Training – Selecting Quality Ldrs        D72    Training the COR
C90    Cub Scout Trainer Wood Badge (1975-2001)       S73    Unit of Training – Boy Scout Ldr Outdoor         D73    Relationships Conference
                 Supplemental Training                S79    Nat. Youth Leadership Training                                Varsity Scout Leader Training
SA     Safety Afloat                                  S90    BS Wood Badge - SM course (1946-1971)                                     Fast Start
SSD    Safe Swim Defense                              S91    BS Wood Badge - Trainer course (1946-1971)       VFS    Varsity Scout Leader Fast Start
D70    Train the Trainer Conference (1950-2001)       S92    BS Wood Badge - Leadership Dev. (1972-2001)                           Youth Protection
D74    Leave No Trace Camping                         S93  Brownsea 22                                        Y01    Youth Protection
D75    Health and Safety training                     S94  Ethics in Action                                                     New Leader Essentials
D76    Merit Badge Counselor Orientation              S95  Troop Operations Workshop                          A01    New Leader Essentials
MS01   Archery Certification                                       Supplemental Training, cont.                      Position Specific- Current & Older Courses
MS02   BB Gun Certification                           S74 Climb on-Safely                                     V21    Varsity Coach Leader Specific
MS03   CPR Training                                   S75 Climbing Instructors B.S.A.                         S11    Introduction to Outdoor Leader Skills
MS04   Canoe Handling                                 S76 Trek Safely                                         V20    Varsity Scout Ldr Fundamentals (1977-2002)
MS05   First Aid                                      WS81 Weather Hazard Training                            V01    Intro. To Varsity Scouting (1977-2002)
MS06   Rifle/Shotgun Certification                    Z01 University of Scouting                              V02    Varsity Scout Leadership (1977-2002)
MS07   Whitewater Safety                              Z02 University of Scouting – Bachelors                  V03    Varsity Scout Program (1977-2002)
MS08   Campmaster Training                            Z03 University of Scouting – Masters                    V31    Varsity Scout Meetings & Activities
MS09   BSA Lifeguard                                  Z04 University of Scouting - Doctorate                  V34    Youth Leaders in Varsity Scouting
MS10   BSA Chainsaw Certification                     Z05    University of Scouting - Post Doctorate Study    V35    Introduction to Leadership
MS12   Training Junior Leaders                                                                                V38    Team Leaders’ Seminar
MS13   Unit Charter Renewal                                                                                   V90    Varsity Scout Leaders’ Wood Badge

             2                                                          Every Boy Deserves A Trained Leader
                                                                                                                                     Adult Leader Training Survey        2008

Code       Course                                       Date   Code     Course                                       Date   Code         Course                                  Date
       Exploring/Learning for Life Leader Training                      National Camp School Training, continued                   Philmont & Other Advanced Courses, continued
                         Fast Start                            CS09   Trek Leader                                           H73     Varsity Scouting in the LDS Church
EFS     Exploring Leader Fast Start                            CS10   Climbing                                              H74     Advanced Boy Scout Camping Skills
                    Youth Protection                           CS11   C.O.P.E.                                              H75     Essentials of Climbing & Rappelling
Y01     Youth Protection                                       CS12   Ranger                                                H76     Mountain Bike Trek Management
                  New Leader Essentials                        CS25   CS/WS Day Camp Management                             H43     Project C.O.P.E. Director Training
A01     New Leader Essentials                                  CS26   CS/WS Resident Camp Management                        H78     Scouting for the Home Schooled
        Position Specific- Current & Older Courses             CS27   CS/WS Day Camp Program                                H79     The Boy Scout Training Continuum
L01     Explorer Leader Adult Basic Training                   CS28   CS/WS Resident Camp Program                           H80     Communicating with Youth
L02     Teacher Training for LFL School Program                CS29   CS/WS Family Camp Administration                      H81     Training Venturing Leaders
E21     Explorer Leader Basic Self-Study Course                CS30   CS/WS Aquatics                                        H82     Venturing in the LDS Church
E01     The Exploring Method                                   CS50   BS Resident Camp Visitation Specialist                H83     Scouting in the Lutheran Church
E02     Post Program Planning                                  CS51   CS Day Camp Visitation Specialist                     H84     Cultural Diversity Conference
E03     Working with Youth                                     CS52   CS Resident Camp Visitation Specialist                H85     Exploring the Scoutmaster’s Handbook
E20     Adult Explorer Ldr Basic Training (1959-1981)                      Philmont & Other Advanced Courses                H86     Small Troop Operations
E30     Sea Explorer Specialized Training (1970-1998)          H01    Administration of Commissioner Science                H87     Council Key 3
E31     Post Officer’s Seminar (1970-1998)                     H02    Administration of Exploring                                    Please note any courses you have completed
E32     Moments in Common                                      H52    Re-Engineering of Scout Training                             which are not listed in any of the above sections
E33     Explorer Program Conference                            H53    Teaching Boy Scout Basic Camping Skills
E34     Explorer Officer’s Association( 1959-1998)             H54    Transitioning to the 21st Century Wood Badge
E90     Advanced Leadership Workshop (1970-1998)               H55    Venturing - The Crew
E91     Sea Badge (Explorer Version) (1948-1998)               H56    Venturing District & Council Administration
E92     Explorer Wood Badge (1948-1960)                        H57    Quality Venturing Roundtables
L03     Career Seminar/Workshop Presenter Training             H58    Venturing Advancement
L04     Post Leader Workshop                                   H59    American Red Cross Instructor
L05     LFL Committee Workshop                                 H60    Scoutreach
L06     LFL Marketing Team Workshop                            H61    Marketing & Public Relations
L07     LFL Program Team Workshop                              H62    Membership/Relationships Committee
L08     Finance Campaigns “How To” in LFL                      H63    New Directions in Cub Scout Training
               National Camp School Training                   H64    Cub Scout Camping
CS01    Management                                             H65    Implementing Trainer Development
CS02    Aquatics                                               H66    Leading Powwows & Universities of Scouting
CS03    Field Sports                                           H67    Pack Trainer
CS04    Chaplain                                               H68    Cub Scout Den Programs
CS05    Program                                                H69    What’s New, Tiger Cub?
CS06    Commissioner                                           H70    Major Gifts/Endowments
CS07    Scoutcraft                                             H71    James E. West Fellowship
CS08    Ecology/Conservation                                   H72    Conducting Troop JLT
                                                                         ********Continued on back********

               3                                                                 Every Boy Deserves A Trained Leader
                                                                                                                       Adult Leader Training Survey    2008

                                                            Adult Leader Awards & Recognition
          Cub Scout Leader Training Awards                  Venturing & Varsity Training Awards                                     Veteran’s Awards
 C43    Tiger Cub Den Leader Award                 P40     Advisor’s Key                                         VT05    Veteran’s Award - 5 years
 C45    Cub Scout Den Leader Award                 P41     Skipper’s Key                                         VT10    Veteran’s Award - 10 years
 C46    Webelos Den Leader Award                   P43     Training Award - Venturing                            VT15    Veteran’s Award - 15 years
 C44    Cubmaster Award                            V33     The Varsity Scout Letter                              VT20    Veteran’s Award - 20 years
 C47    Cub Scouter Award                          V40     The Varsity Coach’s Key                               VT25    Veteran’s Award - 25 years
 C48    Den Leader Coach (No longer Available)     V41     Training Award - Varsity Scouting                     VT30    Veteran’s Award - 30 years
 C49    Tiger Cub Coach (No longer Available)      AMVA    Venturing Advisor Award of Merit                              Veteran’s Award - _____ years
 PT01   Pack Trainer Award (Available 9-1-2008)           District & Council Awards & Recognitions                        Service History                From    To
 HR01   Cubmaster of the Year                      D31     Arrowhead Award                                       Position & unit #                     MM/YY    MM/YY
 HR02   Cub Scout Spark Plug of the Year           D39     Council/Asst. Council Commissioner’s Key              Position & unit #                     MM/YY    MM/YY
         Boy Scout Leader Training Awards          D40     District/Asst. District Commissioner’s Key            Position & unit #                     MM/YY    MM/YY
 S41    Boy Scout Leader’s Training Award          D41     Unit Commissioner’s Key                               Position & unit #                     MM/YY    MM/YY
 S40    Scoutmaster’s Key                          D42     Roundtable Commissioner’s Key                         Position & unit #                     MM/YY    MM/YY
 HR03   Scoutmaster of the Year                    D43     Training Award: Roundtable Staff                      Position & unit #                     MM/YY    MM/YY
 HR04   Boy Scout Spark Plug of the Year           D44     Distinguished Commissioner                            Position & unit #                     MM/YY    MM/YY
 AMSM   Scoutmaster Award of Merit                 D60     District Committee Key                                           Order of the Arrow Recognitions
                    Other Awards                   D61     Silver Beaver                                         O01     Order of the Arrow-Ordeal
 A00    Adult Religious Award                      D62     District Award of Merit                               O02     Order of the Arrow-Brotherhood
                                                   HR05    HRD Hall of Fame Recognition                          O03     Order of the Arrow-Vigil
We thank you for your service to our youth and for taking the time to complete this survey. We want you to know that we are doing our best to make
sure that your record reflects the efforts and time you have invested into the Scouting program and we may contact you to make sure that our records
are as accurate as possible. We appreciate your patience and your cooperation. If you have any questions regarding this form or your training (past or
future), please feel free to contact us.
District Training Chair:                                             District Registrar:
Becki Hume, Salem District Training Chair                            Tammy Fowler, Salem District Registrar
2033 Clayburne Dr., Winston-Salem, NC 27103                          3481 Glen Lyon Dr., Winston-Salem, NC 27107
 (H) 336-760-2725                                                    (H) 336-768-7935                                      
By my signature below and with my oath as a Scouter, I certify that I have completed the courses that I have indicated on the preceding pages and that
the dates are true to the best of my knowledge.

[signature]                                                                                             [date]
              4                                                    Every Boy Deserves A Trained Leader

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