Black River District

BLACK RIVER DISTRICT DISTRICT AWARD OF MERIT 2016 NOMINATION FORM Please return all nominations to Marc Maratea by March 1, 2016 Please complete both sides

Nominee’s Name: ______Address: ______Phone: ______Current Scouting Position ______Unit ______Years in Current Position ______1. Youth Scouting Experience Cub Scout – Highest Rank Received ______Boy Scout – Highest Rank Received ______Girl Scout – Highest Rank Received ______Explorer – Highest Rank Received ______Special Youth Awards/Recognitions ______2. Adult BSA training courses completed (check all that apply) _____ Youth Protection Training _____ Webelos Leader Outdoor _____ Risk Zone _____ BALOO _____ SSD/SA _____ Boy Scout Leader Specifics _____ Essentials _____ Outdoor Skills _____ Cub Leader Specifics _____ Wood Badge Additional BSA training courses ______3. List all Scouting awards and recognitions which this leader has received ______4. Please describe ways in which this leader has helped their pack, troop or crew to succeed during the past year (for example: finance, membership, program, etc.) Be Specific ______5. Please list any involvement that this leader has had on a district level during the past year (for example: member of the district committee, commissioner, popcorn kernel, friends of scouting, etc.) Be Specific ______6. Please list any involvement that this leader has had on a council level during the past year (for example: member of a council committee, led a high adventure trek, council wide special activity, etc.) Be Specific

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7. Please note any other Scout related responsibilities or activities for this leader during the past year that were not addressed on this nomination form:

______8. Please describe this leader’s involvement within their church, community, service club or other groups and organizations other than Scouting:

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Additional information (if needed) ______

All awards will be presented at the Black River District Dinner in 2016. It is hopeful that the recipient, nominator and guests will attend to accept the award. Some units choose to purchase two seats for the award recipient and spouse as a thank you when purchasing seats for attendees from the unit to help recognize this great accomplishment.

Person submitting nomination (Please print):______Address ______Phone ______Position in Scouting ______E-Mail Address ______