Merit Badge Counselor App0602 by VNZSl3

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									Ventura County Council                                                                                                      Boy Scouts of America

                                 MERIT BADGE COUNSELOR APPLICATION
Please Type or Print

Name: _________________________________ M/F: ________ Day Phone: (____)_______________

Address: ____________________________________________ Evening Phone: (____)____________

Email Address (please print legibly)____________________________________________________

City: ______________________ State: __________ Zip Code: _________ Birth Date:_____________

To qualify as a merit badge counselor, you must:                                   As a merit Badge counselor, I agree to:
* Be at least 18 years old.                                                        * Follow the requirements of the merit badge, making
* Be proficient in the merit badge subject by vocation                                no deletions/additions, ensuring that the advance-
  or avocation.                                                                       ment standards are fair and uniform for all Scouts.
* Be able to work with Scout-age boys.                                             * Have 2 or more persons present at all instructional
* Renew my commitment annually if I plan to continue                                  sessions.
  as a merit badge counselor.                                                      * Be registered with the Boy Scouts of America as a
                                                                                      a Merit Badge Counselor (Code 42).
                                                         Is this subject in line with     Do you follow subject         If not, do you have any
                                                         your job, business or pro-       as a hobby, having more       special training or other
                                                         fession? If yes, give a brief than a working knowledge qualifications for this subject?
    (See list on reverse side)                           information on the reverse of the requirements in the          If yes, give brief information
    List Merit Badge Subjects                            side.                            merit badge pamphlet.         On the reverse side.

    1.

    2.

    3.

    4.

    5.

    6.

(___) My BSA Adult Registration Application to be a Merit Badge Counselor is attached (See comments on reverse side)

Other Scout Affiliation: Position: ________________ Unit No: ___________ District/Community: _________________

Signature: _________________________________________________Date: _________________________

                                        Please read and complete both sides of this form and
                                   an Adult Registration Application for the Boy Scouts of America.

                  UNTIL YOUR APPLICATION HAS BEEN APPROVED AND YOU HAVE BEEN NOTIFIED.
                YOU ARE NOT AUTHORIZED TO ACT IN THE CAPACITY OF A MERIT BADGE COUNSELOR .


 Approved   ‫ٱ‬     Disapproved    ‫_______________________ ٱ‬                                                        Date:    ____________
                                                             Advancement Committee
                     MBC Notified by:      _______________________                                                Date:    ____________
                                                             (Phone, Letter, or email)

n:administration/forms/merit badge counselor app                                                                                     Rev 6/27/02
Ventura County Council                                                                                                  Boy Scouts of America

                                                           MERIT BADGES
‫ ڤ‬American Business                   ‫ ڤ‬Cooking                             ‫ ڤ‬Indian Lore                         ‫ ڤ‬Reading
‫ ڤ‬American Cultures                   ‫ ڤ‬Crime Prevention                    ‫ ڤ‬Insect Study                        ‫ ڤ‬Reptile and Amphibian Study
‫ ڤ‬American Heritage                   ‫ ڤ‬Cycling **                          ‫ ڤ‬Journalism                          ‫ ڤ‬Rifle shooting
‫ ڤ‬American Labor                      ‫ ڤ‬Dentistry                           ‫ ڤ‬Landscape Architecture              ‫ ڤ‬Rowing
‫ ڤ‬Animal Science                      ‫ ڤ‬Disabilities Awareness              ‫ ڤ‬Law                                 ‫ ڤ‬Safety
‫ ڤ‬Archaeology                         ‫ ڤ‬Dog Care                            ‫ ڤ‬Leatherwork                         ‫ ڤ‬Salesmanship
‫ ڤ‬Archery                             ‫ ڤ‬Drafting                            ‫ ڤ‬Lifesaving **                       ‫ ڤ‬Scholarship
‫ ڤ‬Architecture                        ‫ ڤ‬Electricity                         ‫ ڤ‬Mammal Study                        ‫ ڤ‬Sculpture
‫ ڤ‬Art                                 ‫ ڤ‬Electronics                         ‫ ڤ‬Medicine                            ‫ ڤ‬Shotgun shooting
‫ ڤ‬Astronomy                           ‫ ڤ‬Emergency Preparedness **           ‫ ڤ‬Metalwork                           ‫ ڤ‬Skating
‫ ڤ‬Athletics                           ‫ ڤ‬Energy                              ‫ ڤ‬Model Design and Building           ‫ ڤ‬Small-Boat Sailing
‫ ڤ‬Atomic Energy                       ‫ ڤ‬Engineering                         ‫ ڤ‬Motor boating                       ‫ ڤ‬Snow Sports
‫ ڤ‬Auto Mechanics                      ‫ ڤ‬Entrepreneurship                    ‫ ڤ‬Music                               ‫ ڤ‬Soil and Water Conservation
‫ ڤ‬Aviation                            ‫ ڤ‬Environmental Science **            ‫ ڤ‬Nature                              ‫ ڤ‬Space Exploration
‫ ڤ‬Backpacking                         ‫ ڤ‬Family Life **                      ‫ ڤ‬Oceanography                        ‫ ڤ‬Sports
‫ ڤ‬Basketry                            ‫ ڤ‬Farm Mechanics                      ‫ ڤ‬Orienteering                        ‫ ڤ‬Stamp Collecting
‫ ڤ‬Bird Study                          ‫ ڤ‬Fingerprinting                      ‫ ڤ‬Painting                            ‫ ڤ‬Surveying
‫ ڤ‬Bugling                             ‫ ڤ‬Fire Safety                         ‫ ڤ‬Personal Fitness **                 ‫ ڤ‬Swimming **
‫ ڤ‬Camping **                          ‫ ڤ‬First Aid **                        ‫ ڤ‬Personal Management **              ‫ ڤ‬Textile
‫ ڤ‬Canoeing                            ‫ ڤ‬Fish and Wildlife Management        ‫ ڤ‬Pets                                ‫ ڤ‬Theater
‫ ڤ‬Chemistry                           ‫ ڤ‬Fishing                             ‫ ڤ‬Photography                         ‫ ڤ‬Traffic Safety
‫ ڤ‬Cinematography                      ‫ ڤ‬Forestry                            ‫ ڤ‬Pioneering                          ‫ ڤ‬Truck Transportation
‫ ڤ‬Citizenship in the Community**      ‫ ڤ‬Gardening                           ‫ ڤ‬Plant Science                       ‫ ڤ‬Veterinary Medicine
‫ ڤ‬Citizenship in the Nation **        ‫ ڤ‬Genealogy                           ‫ ڤ‬Plumbing                            ‫ ڤ‬Water skiing
‫ ڤ‬Citizenship in the World **         ‫ ڤ‬Geology                             ‫ ڤ‬Pottery                             ‫ ڤ‬Weather
‫ ڤ‬Climbing                            ‫ ڤ‬Golf                                ‫ ڤ‬Public Health                       ‫ ڤ‬Whitewater
‫ ڤ‬Coin Collecting                     ‫ ڤ‬Graphic Arts                        ‫ ڤ‬Public Speaking                     ‫ ڤ‬Wilderness Survival
‫ ڤ‬Collections                         ‫ ڤ‬Hiking **                           ‫ ڤ‬Pulp and Paper                      ‫ ڤ‬Wood Carving
‫ ڤ‬Communications **                   ‫ ڤ‬Home Repairs                        ‫ ڤ‬Radio                               ‫ ڤ‬Woodwork
‫ ڤ‬Computers                           ‫ ڤ‬Horsemanship                        ‫ ڤ‬Railroading

(Note: Merit badges with ** are those that are Eagle required.)

                                                              ***************
Registration:
     1.   There is no fee required to register as a Merit Badge Counselor.
                                                                   ***HOWEVER***
     2.   If you are NOT registered elsewhere in this Council and want to be on the mailing list to receive our newsletter and Scouting Magazine,
          there is annual registration fee.
     3.   All applicants registering as a Merit Badge Counselor, whether paying or not, MUST complete and Adult Application whether registered in
          another position or not. In the upper right-hand corner of the application where it says “Council/District Position’, write in ‘Merit Badge
          Counselor’.
     4.   Use the remainder of this page to give, in a few brief sentences, your background and qualifications for counseling the merit badge(s) you
          have selected. Acceptable qualifications include being expert or knowledgeable because of 1) your work, 2) specialized training, 3) a
          strong avocation interest that qualifies you. Just having general interest or common knowledge of a subject does not qualify you for
          approval as a Counselor.

Background/ Qualifications:




n:administration/forms/merit badge counselor app                                                                                 Rev 6/27/02

								
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