Baltimore Area Council/Boy Scouts of America/National Pike District

Baltimore Area Council Boy Scouts of America

CARROLL DISTRICT MERIT BADGE C0UNSELOR APPLICATION (Submit this form only to Carroll District’s Dean of Merit Badge Counselors via Email, fax or mail) (Butch Colby, 9 Hayride Lane, Taneytown, MD 21787 – Ph: 410 756-2652 – Fax 410 756-1954) Email: [email protected]

Name (Print) ______Age _____ Date of Birth ______Address: ______Home Phone: ______City: ______State ______Zip ______Employed by: ______Occupation: ______Bus. Phone: ______Note: If you are a registered leader in Carroll District, please provide that information on the next line: Type of Unit: ______Unit #: ______Position: ______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 no deletions or additions Be proficient in the merit badge subject Ensure the advancement standards are fair and uniform for all Scouts Be able to work with Scout-age boys Have two or more people present at all instructional sessions Be registered with the Boy Scouts of America Renew my registration annually, if I plan to continue as a merit badge counselor. I am applying to be a merit badge counselor for the following badges: 1. 4. 7. 2. 5. 8. 3. 6. 9. Do you earn a living or have special training using these talents covered in the merit badges listed above? If so describe briefly: ______Do you have a hobby, which uses the skills covered in the merit badges listed above? If so, describe briefly: ______CHECK ONE AND OBTAIN UNIT APPROVAL ___ I wish to serve as a merit badge counselor for Unit # ______and do not wish to be part of the district listing. ___ I wish to serve as a merit badge counselor for the district as well as my troop, if applicable. Unit Approval: ______Date: ______Unit # ______Title: ______Phone: ______I am NOT currently registered (as a merit badge counselor) with the Boy Scouts of America. There fore, I have attached an adult application form to be a member of the Boy Scouts of America. There is NO registration fee for merit badge counselors. On the line on the adult application that asks for code, insert 42.

____ I am already registered as a merit badge counselor with the Boy Scouts of America, in Carroll District and do not need to attach an adult application.

As the applicant, I gave my permission for my name, address, and home phone number to be published in Carroll District’s Merit Badge Counselor Reports, so that Boy Scouts may be able to contact me to act as their Merit Badge Counselor.

Applicant’s Signature: ______Date: ______

Approved by District Dean of Merit Badge Counselors ______Date: ______

Checked by registrar: ______Recorded by Advancement Clerk: ______