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APPLICANT’S RECORD
Name ________________________________________ has given me his completed application for the _____________________________________________ Merit BadgeCompleted on __________/_________/_________ by _____________________________________________ Signature of Counselor _____________________________________________ Signature of unit leader
NOTE TO BOY SCOUT, VARSITY SCOUT, OREXPLORER: Retain this copy for your permanentrecords.COUNSELOR’S RECORD
Applicant ___________________________________
o
Troop
o
Team Unit number: ____________________
o
Post __________________________________________ Merit BadgeDate Completed _________/_________/__________ Remarks:
It is suggested that the counselor keep this recordfor at least 1 year in case any question is raisedlater in regard to this award.
The applicant has personally appeared before meand demonstrated to my satisfaction that he has metall requirements for the (please print):
________________________________________________ Merit Badge ________________________________________________ Name of Counselor ________________________________________________ Address of Counselor ________________________________________________ CityZIP Code ________________________________________________ Telephone number of Counselor _____________________________________/_____/_____ Signature of counselor DateChecked and recorded: ________________________________________________ DateInitialsCertificate and badge presented: _____________________ Date
Applicant will turn in this portion to his unitleader for record posting.
The applicant has personally appeared before meand demonstrated to my satisfaction that he has metall requirements for the (please print):
________________________________________________ Merit Badge ________________________________________________ Name of Counselor ________________________________________________ Address of Counselor ________________________________________________ CityZIP Code ________________________________________________ Telephone number of Counselor _____________________________________/_____/_____ Signature of counselor DateChecked and recorded: ________________________________________________ DateInitialsCertificate and badge presented: _____________________ Date
Applicant will turn in this portion to his unitleader for record posting.
The applicant has personally appeared before meand demonstrated to my satisfaction that he has metall requirements for the (please print):
________________________________________________ Merit Badge ________________________________________________ Name of Counselor ________________________________________________ Address of Counselor ________________________________________________ CityZIP Code ________________________________________________ Telephone number of Counselor _____________________________________/_____/_____ Signature of counselor DateChecked and recorded: ________________________________________________ DateInitialsCertificate and badge presented: _____________________ Date
Applicant will turn in this portion to his unitleader for record posting.APPLICANT’S RECORD
Name ________________________________________ has given me his completed application for the _____________________________________________ Merit BadgeCompleted on __________/_________/_________ by _____________________________________________ Signature of Counselor _____________________________________________ Signature of unit leader
NOTE TO BOY SCOUT, VARSITY SCOUT, OREXPLORER: Retain this copy for your permanentrecords.APPLICANT’S RECORD
Name ________________________________________ has given me his completed application for the _____________________________________________ Merit BadgeCompleted on __________/_________/_________ by _____________________________________________ Signature of Counselor _____________________________________________ Signature of unit leader
NOTE TO BOY SCOUT, VARSITY SCOUT, OREXPLORER: Retain this copy for your permanentCOUNSELOR’S RECORD
Applicant ___________________________________
o
Troop
o
Team Unit number: ____________________
o
Post __________________________________________ Merit BadgeDate Completed _________/_________/__________ Remarks:
It is suggested that the counselor keep this recordfor at least 1 year in case any question is raisedlater in regard to this award.COUNSELOR’S RECORD
Applicant ___________________________________
o
Troop
o
Team Unit number: ____________________
o
Post __________________________________________ Merit BadgeDate Completed _________/_________/__________ Remarks:
It is suggested that the counselor keep this recordfor at least 1 year in case any question is raisedlater in reard to this award.
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