2017 National Scout Jamboree PROSPECTIVE CONTINGENT LEADER PROFILE
Name ______Home Phone ______
Address ______Work Phone ______
City, Zip ______E-mail ______
Occupation ______Employer ______
Jamboree Registration Code: ______
District (Circle one) Northstar Pon Man Ottawa Chippewa Sunset Mahican Sunrise Renaissance
Unit _____ Current Position ______Years of Service ____ Prior Scouting Positions: Unit ____ Position ______Years of Service ____
Unit __ Position ______Years of Service ____
Unit __ Position ______Years of Service ____
Years in Scouting: Youth: Cub Scouts _ Boy Scouts _ Exploring/Venture ____
Adult: Cub Scouts Boy Scouts _ Exploring/Venture ____
Awards: Arrow of Light ____ Eagle Scout ______Other ______
Hobbies ______
Other Skills ______
Summer Camp your Unit Attends (Circle one) COLE Canoe Base D-Bar-A Other: ______
Training (year): Fast Start ______Scout Leader Fundamentals ______Wood Badge ______
Training Courses Staffed? ______
Great Lakes Field Service Council, Michigan Crossroads Council BOY SCOUTS OF AMERICA Dauch Scout Center – 1776 West Warren Avenue, Detroit, MI 48208 Phone 313-897-1965/Fax 313-897-2083
Events Attended: District Camporee(s) ______Other ______National Jamboree (Year) ______Position ______National Order of the Arrow Conference(s) ______Word Jamboree (Year) ____ Position _____ High Adventure: Philmont (Year) _____ Position ______Sea Base (Year) ______Northern Tier (Year) ______Summit (Year) Jamboree Position Applying For: Scoutmaster ______1st Asst. Scoutmaster _____ 2nd Asst. Scoutmaster _____ 3rd Asst. Scoutmaster _____
CHECK ALL OF THE FOLLOWING AWARDS YOU HAVE RECEIVED: _____ Eagle Scout Award _____ Religious Awards (as a Youth ______Adult ______) _____ Scouters Award (Program(S) ______) _____ Wood Badge Staff (year ______Position ______) _____ District Award of Merit (District ______) _____ Silver Beaver Award (Council ______) _____ Silver Antelope Award (Region ______) _____ Silver Buffalo Award (National ______) _____ James E. West Fellow (Council ______) _____ 1910 Society Member (Council ______) _____ Heritage Society Member (Council ______) _____ Order of the Arrow Membership ______Ordeal ______Brotherhood ______Vigil Honor
Other awards or special recognition: ______
Other things the selection committee should know about you: ______
Great Lakes Field Service Council, Michigan Crossroads Council BOY SCOUTS OF AMERICA Dauch Scout Center – 1776 West Warren Avenue, Detroit, MI 48208 Phone 313-897-1965/Fax 313-897-2083