Ktemaque Lodge #15 WWW - Order of the Arrow - Westchester-Putnam Council - Boy Scouts of America

Ktemaque Lodge #15 WWW Order of the Arrow Westchester-Putnam Council Boy Scouts of America

Adult Nomination Form

April 1 is the DEADLINE to send this form via mail (postmark) or email.

Name Date

Address

City State Zip

Occupation Special Skills

Phone Home

Phone Cell

Phone Work

Email Address

Date of Birth

is registered with (Unit#, Community or District or Council) BSA Registration Number (REQUIRED):

Primary Scouting position After registration with a troop or team, this nominee has experienced 15 days and nights of Boy Scout camping during the two-year period prior to the nomination. The 15 days and nights must include one, but no more than one, long-term camp consisting of six consecutive days and five nights of resident camping, approved and under the auspices and standards of the Boy Scouts of America. The balance of the camping must be overnight, weekend, or other short-term camps under the auspices and standards of the Boy Scouts of America.

Long-term camping days and nights under the auspices and standards of # the Boy Scouts of America in the two-year period prior to the nomination.

Short-term camping days and nights under the auspices and standards of # the Boy Scouts of America in the two-year period prior to the nomination.

Adult Nomination Form Ktemaque Lodge #15 WWW - Order of the Arrow - Westchester-Putnam Council - Boy Scouts of America

(List of camping dates and places must be included in the Letter of Recommendation.)

Number of boys elected from unit

Date of Election I have spoken to the nominee and he has agreed to help in the following areas (check all that ally):

OA Service/Induction Weekends

Promote Camping

Serve as an OA Advisor

Help at Service weekends

Other:

I certify that the Nominee is a currently registered Scouter and provides a positive example for the growth and development of the youth members of the Boy Scouts of America. I also certify that the information listed on this form is true and correct.

Unit Leader Name Unit Leader Signature

Committee Chairman Name Committee Chairman Signature

Adult Nomination Form Ktemaque Lodge #15 WWW - Order of the Arrow - Westchester-Putnam Council - Boy Scouts of America

Special Instructions:

1. Adults are 21 years and older. 2. A letter of recommendation to the Lodge Selection Committee must accompany this form. The letter must answer the following questions: • Selection of the adult is based on the ability to perform the necessary functions to help the Order fulfill its purpose, and not for recognition of service, including current or prior achievement and positions. This individual's abilities include: • This adult will be an asset to the Order due to demonstrated abilities that fulfill the purpose of the Order because: • This adult leader's membership will provide a positive example for the growth and development of the youth members of the Lodge because: • Please list camping dates and places within the past two years. 3. Send this form, the letter of recommendation, and the list of camping dates and places to the following address or by email to [email protected] by the April 1 deadline. Ktemaque Lodge #15 Adult Nomination 41 Saw Mill River Rd Hawthorne, NY 10532-1519 All information requested must be supplied. Adult nominations postmarked after April 1st will not be considered.

Adult Nomination Form