Far East Council MERIT BADGE COUNSELOR Application

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					                                             Boy Scouts of America
                         Far East Council MERIT BADGE COUNSELOR
                                          Application

(Please type or print)

Name ______________________________________________Age _____ Business Phone (____) ________________

Address _______________________________________________________ Home Phone (____) _______________

City ___________________ State ______ Zip Code ____________BSA Member Number _______________________

E-Mail Address ________________________________________@ _______________________________________

Sign-Up Date: ____________Expiration Date_______________Youth Protection Training Date___________________


To qualify as a merit badge counselor, you must:              As a merit badge counselor, I agree to:
•   Be at least 18 years old and Youth Protection             •   Follow the requirements of the merit badge, making no
    Trained.                                                      deletions or additions, ensuring that the advancement
•   Be proficient in the merit badge subject by vocation          standards are fair and uniform for all scouts.
    or avocation.                                             •   Have a Scout and his buddy present at all instructional
•   Be able to work with Scout-age boys                           sessions. Follow 2-Deep Leadership at all times.
•   Be registered with the Boy Scouts of America              •   Be Youth Protection Trained within 90 days after
•   Will make current updates/changes to merit badge              submitting application
    application throughout the year as needed until           •   Renew my registration annually if I plan to continue
    application has expired                                       as a merit badge counselor


There is no fee for becoming a merit badge counselor. You need only to submit this form and a BSA Adult
Application Form upon initial registration annually. Confirmation of your continued interest in serving as a merit
badge counselor should resubmitted on an annual basis.

                                   Additional Requirements for Specific Merit Badges:
** The Rifle Shooting merit badge counselor must be a currently NRA-certified rifle instructor, or Range Saftey Officer
Certified. Please attach a copy of your certification to this application.

** The Shotgun Shooting merit badge counselor must be a currently NRA-certified shotgun instructor or coach who is 21
years of age or older. Please attach a copy of your certification to this application.

 ++ All Climbing and rappelling activities must be supervised by an Instructor who is 21 years of age or older and has
successfully completed a minimum of 10 hours of instructor training for climbing/rappelling from a nationally or regionally
recognized organization, a climbing school, a college-level climbing/rappelling course, or is a certified BSA climbing
instructor. For every 10 scouts there must be an additional adult 18 years or older present. Please attach a copy of your
certification to this application.

 * Counselors for aquatics merit badges (Swimming, Lifesaving, Canoeing, Rowing, Small Boat Sailing, Whitewater,
Waterskiing, and Motor boating) must have current Safety Afloat and Safe Swim Defense training (available online).
Please attach a copy of your certification to this application. Counselors for Scuba BSA must hold current scuba instructor
certification from PADI, NAUI, SSI, or other RSTC member organizations. Instruction must comply with RSTC standards
for introductory scuba experiences.

** First Aid merit badge counselors must have current CPR and First Aid training/certified by the American Red Cross or
American Heart Association. Please attach a copy of your certification to this application.
                                        List your qualifications for each merit badge, such as          If badge requires special BSA
                                        applicable college degrees, formal training, specific           training, please list dates of
                                        certifications, license, special education, life experiences,   training below:
                                        job experiences, scout experience, and or membership in
                                        any professional organization that qualifies you to teach
                                        the merit badge (s): (Use back of form is necessary)
     List Merit Badge ID # (listed in
     packet) and Badge Name:

1.

2.

3.

4.

5.

6.

7.

Do not forget to list your qualifications for each merit badge you sign up to teach and if more space is needed please
attach another sheet to this application.

As the applicant, I give permission for my name, full address and phone number, to be published in a hard copy
document for distribution and use by registered Troop Leaders of the Council. By signing, I hereby give my
consent and approval and hold harmless the Council, Boy Scouts of America and the National Council, Boy
Scouts of America and the officers, employees, and volunteers thereof.
Additionally, by signing this form I affirm that I DO wish to be listed on the “Merit Badge Counselor List” on the
Council, and affiliated BSA websites, and DO AGREE to have ONLY my name, phone number, and BSA Unit
Affiliation (full address will not be posted). I also understand that I can request my name to be removed at any
time by contacting the Council.


Printed Name_________________________________Signature_________________________Date________________

I wish to work with __________ All Units or _______________ Unit Only.

Note: New Application for Non-Unit Registrants must be attached. All Current Unit Registrants must attach a copy of their
processed application.


                                                Council Use Only
                            Council approval by ______________________ Date ________________

 Background check completed __________Name entered in computer_________Added to List & Website___________

				
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posted:2/11/2012
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