Adult Troop/Crew Leader Application Form – Part 1 Northeast Region

Notes: Before applying, please review the selection criteria. We anticipate numerous applicants; if you do not meet most of the criteria, please do not apply. Remember to make a copy for your file. For NER Lead SMs and Crew Leaders and Assistants, use this form to apply. Deadline: 2/15/14

(Please Print or Type)

Address: City: Home Phone: ( E-mail: Region: Northeast ) State: Zip: Business/Cell Phone: ( Birthday (mo/day/yr): Your Council # & Headquarter City: ) Age:

Qualifications: 1. Prior World Scout Jamboree leader? If yes, position, year and country:


Prior National Jamboree leader? If yes, position and year:


Experience as troop Scoutmaster/Crew Leader? If yes, unit number, years and currently Scoutmaster/Crew Leader:

4. 5. 6.

Excellent health and fitness: Wood Badge trained? If yes, year: Foreign travel experience? If yes, where and when (if travel frequently, list various examples):

7. 8. 9.

Will you have a son or daughter applying to attend? Are you able to commit the time for pre-jamboree development of a unit? List other qualification relating to the leadership criteria that would make you a good candidate for troop/crew leadership in 2015(attach a separate typed sheet if necessary):

Submit to: (Email is Preferred)

Mark Kriebel NER WSJ Chairman 400 Sunrise Drive Endwell NY 13760


Jim Hans NER WSJ Regional Coordinator 1325 W. Walnut Hill Lane Irving, TX 75038

Part 1: The Northeast Region application deadline for consideration is 2/15/14; do NOT send any fees with this application. Send this NER application to Mark and to Jim. Part 2: Applicants may apply at Applications must be approved by the applicant’s local council and region. Jamboree fee payments will be made online through the same link.

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