Grand Columbia Council Scouter History Name: District: Record of Service As Of Date: Tenure Dates Type Position Unit No District Council From To Total Years Charter Organization Chartered Organization Representative Committee Chair Committee Member Other: Cub Cubmaster Assistant Cubmaster Tiger Cub Coach Den Leader Assistant Den Leader Webelos Den Leader Assistant Webelos Den Leader Other: Other: Boy Scout Scoutmaster Assistant Scoutmaster Other: Other: Varsity Varsity Coach Assistant Varsity Coach Venturing Crew Advisor Assistant Venturing Crew Advisor Sea Scouts Skipper Mate District District Chair District Vice Chair District Committee Member District Commissioner Assistant District Commissioner Unit Commissioner Merit Badge Counselor Other: Other: Roundtable Roundtable Commissioner Cub Scout Roundtable Staff Boy Scout Roundtable Commissioner Boy Scout Roundtable Staff Varsity Roundtable Commissioner Varsity Roundtable Staff Venturing Roundtable Commissioner Venturing Roundtable Staff Other: OA Lodge Advisor OA Lodge Associate Advisor OA Chapter Advisor OA Chapter Associate Advisor Other: Council Council Board Chair Council Commissioner Assistant Council Commissioner Council Board Member Council Committee Chair Council Committee Member Scoutmaster Jamboree Assistant Scoutmaster Venturing Officers Association Advisor Member-at-Large Honorary Life Member Other: Other: Total Number of Years of Service as a Registered Adult Volunteer: Record of Service Grand Columbia Council Scouter History

Training History Year(s) of Completion Youth Adult Type Training Course Participant Staff Participant Staff Basic Cub Scout Den Leader Position-Specific Training Boy Scout Scoutmaster Position-Specific Training Varsity Team Coach Position-Specific Training Venturing Crew Advisor Position-Specific Training Introduction to Outdoor Leadership Skills (IOLS) Troop Committee Challenge Team Committee Challenge Crew Committee Challenge Merit Badge Counselor Orientation Other: Other: Advanced National Camping School Philmont Leadership Challenge Conference Florida Sea Base Conference Basic Adult Leader Outdoor Orientation (BALOO) Other: Other: Commissioner Commissioner Training - Basic Commissioner Training - Bachelors Degree Commissioner Training - Masters Degree Commissioner Training - Doctorate Degree Other: Other: Youth Kodiak or Kodiak X Powder Horn Order of the Arrow National Leadership Seminar (NLS) National Junior Leadership Instructor Camp (NJLIC) National Youth Leadership Training (NYLT) National Advanced Youth Leadership Experience (NAYLE) Introduction to Leadership Skills for Troops Introduction to Leadership Skills for Teams Introduction to Leadership Skills for Crews Venturing Goal Setting and Time Management Venturing Project Management Venturing Mentoring Other: Other: Specialty Wilderness First Aid Leave No Trace Trainer STEM Nova Counselor STEM Supernova Mentor Other: Other:

Journey to Excellence/Quality Unit/Honor Unit History (Including Committee Participation) Description ("Quality Unit 1989, JTE Bronze 2013/2014, JTE Gold 2015/2016") Unit Pack Troop Team Crew Ship District/Council District Council Other Order of the Arrow Lodge Council Venturing Other: Training-JTE History Grand Columbia Council Scouter History

Scouting Recognition Year(s) of Program Specific Year(s) of Completion Type Scouting Honor Completion Cub Scout Boy Scout Varsity Venturing Youth Arrow of Light Eagle Scout Merit Badges / Eagle Palms (specify numbers) / Varsity Letter Varsity Denali Venturing Silver/Summit (specify) Venturing /Quest/Trust (specify) Quartermaster Youth Religious Award Den Chief Service Award 50 Miler Award National National Outdoor Award (specify) National Medal for Outdoor Achievement Unit Den Leader's Training Award Scouter's Training Award Scouter's Key Unit Leader Award of Merit Adult Religious Award William D Boyce New Unit Organizer Award NESA National Eagle Scout Association (NESA) Member NESA Outstanding Eagle Scout Award NESA Distinguished Eagle Scout Award Jamboree National Jamboree Participant/Staff World Jamboree Participant/Staff Order of the Arrow OA Member OA Vigil Honor Wdallowelemui Award (Tataliya Lodge) Founder's Award OA Unit/Representative of Excellence Award OA Advisor/Scoutmaster of Excellence Award OA Distinguished Service Award District District Award of Merit "Scouter of the Year" Award Commissioner Arrowhead Honor Commissioner Award of Excellence in Unit Service Doctor of Commissioner's Science Distinguished Commissioner Service Award Council Silver Beaver James E West Society Fellowship Award Grand Columbia Council Chinook Society 1910 Society Founders Circle Professional Scouter Training Award Bravery Medal of Merit Honor Medal Other Philmont Training Center Master's Knot Alumni Award Knot George Meany Award Scouting Service Award Community Organization Award William T Hornaday Award (specify) William H Spurgeon III Award Venturing Leadership Award (specify) International Scouter Award Other: Other: Scouting Recognition Grand Columbia Council Scouter History

Record of Other Service Tenure Dates Type Organization Name Position From To Total Years Accomplishments Religious Religious Organization Member Religious Leader Other: Other: Civic Civic Organization Member Other: Other: Service Service Organization/Club Member Other: Other: Professional Professional Organization Member Other: Other: Fraternal Fraternal Organization Member Other: Other: Veterans Veterans Organization Member Other: Other: Other Other Organization Member Other: Other:

Additional Noteworthy Comments on Your Service of Character to Youth:

Other Notable Service or Comments Regarding Community Involvement:

Eagle Scout Children or Eagle Scouts from Who You Have Received Mentor Recognition: Children:

Mentorees:

Other Service