The Nomination Form

The Silver Buffalo Award, created in 1925, is bestowed upon those who give truly noteworthy and extraordinary service to youth. This award, ’s highest commendation, recognizes the invaluable contributions that outstanding American men and women render to youth. The service must be national in character and may or may not be directly connected with the BSA. To prevent embarrassment, the candidate should not be notified of the nomination.

Name ______Spouse’s name ______

Home address ______

City ______State ______Zip code ______

Country ______Home phone ______Mobile phone ______

Company name ______Professional title ______

Business address ______

City ______State ______Zip code ______

Business phone ______Email ______

I confirm that the nominee lives by the principles of the Oath and in word and deed, and is exemplary in his or her personal, family, and professional activities.

Confirmation by person submitting nomination______(Printed name)

Date ______(Signature)

Nominator’s contact phone ______Email ______

Name and location of nominee’s local council ______

Scout executive approval ______

MAJOR ELECTED AND APPOINTED SCOUTING POSITIONS

NATIONAL Position From To

______

REGIONAL ______

AREA ______

COUNCIL ______

DISTRICT ______

UNIT ______

Youth Scouting tenure ______Adult Scouting tenure ______

SCOUTING RECOGNITION

Scouting Honors Type Year Type Year Type Year Eagle Scout National Eagle Scout Association Distinguished Eagle Scout Award God and Country God and Service Arrow of Light Award member Order of the Arrow Vigil Honor Whitney M. Young Jr. Service Award James E. West Society Fellowship Award District Award of Merit Scoutmaster Award of Merit Unit Leader Award of Merit Silver Award Scouter’s Key Scouter’s Training Award Other Scouting Awards Type Year Type Year Type Year

PERSONAL HIGHLIGHTS

A. Non-Scouting honors received indicative of major service to youth:

B. What is the single most noteworthy service to youth made by this person that is national in character and far beyond what any outstanding volunteer might do?

C. Business, professional, civic, and community contributions to youth:

D. Religious offices impacting youth:

EDUCATIONAL BACKGROUND

Degree School

______

HONORARIUMS

INSTRUCTIONS RULES AND REGULATIONS of the 1. This official nomination form must be used.

2. Give the nominee’s full name and title; avoid Article X, Section 6, Clause 1 the use of nicknames. Silver Buffalo Award 3. Provide as much information as necessary

using the space provided on this form. No The Boy Scouts of America may award the additional documents should be attached Silver Buffalo for distinguished service to other than supporting letters of citizens of the United States upon the following recommendation. Supporting letters are basis and procedure: accepted electronically and should provide a) These awards may be made each year. supporting evidence of worthiness to earn b) The award is made on the basis of the award, not just personal noteworthy service to youth, of a recommendations or endorsements. national or international character, 4. Nomination forms submitted are for three outside of the line of regular duty, years from the date of submission. either directly to or independent of the 5. Nomination forms must be submitted Boy Scouts of America. electronically to the National Council no later c) As evidence of the award there shall be than August 31 for recognition the following presented: a suitable certificate, year. descriptive of the services rendered,

duly authenticated by the Boy Scouts of

America, pursuant to the action of the

Executive Board; and a miniature Silver

Buffalo, suspended by a red, white, and Submit electronic nomination forms and red ribbon to be worn around the neck. supporting documents to: d) These awards shall be made at the [email protected] meeting of the National Council or at a

major function of the Boy Scouts of America, pursuant to the action of the Executive Board, which action shall be based upon recommendation to the Executive Board by the National Court of Honor, or by recommendations to the Executive Board by the president of the corporation and the .

512-102 2011 Printing