Merit Badge Application Instructions to Scout: Press F1 for help for anyblank.
• Print your name, address, city, unit
for this merit badge on District's list.
along with a buddy (a Scout, friend,
type &number, District, Council &
• Your unit leadersigns &dates.
or parent).
Merit Badge legibly.
•Read the merit badge pamphlet.
•Your Leader must verify that the
•Call counselorfor appointment.
Atjplicant's Section
Counselor's Section
Council Section
APPLICATION FOR
MERIT BADGE
Information for Applicant
A merit badge application can be approvedonly
bya registered merit badge counselor.
You must have a buddywithyou (Scout buddy
system) at each meeting with the merit badge
Name \/vlg^e.^ f^Jr?
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Address J*j£ £&r<\bff Vd\ \i
Cityj££e<Qr<9
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counselor.
Turn inyourapproved application to your unit
leader. You will be awarded the merit badgeand
is a registered
certificate at a suitable occasion.
19 Boy Scout • Varsity Scout • Venturer
II
Information for Counselor
of
£ 2
Troop
No.
\Sl} .
Troop,team, crow,ship
Merit badge applications must be signed in
advance bythe applicant's unitleader.
TheScoutmusthave his buddy(Scoutbuddy
system) inattendanceat allinstructional sessions.
You may notchangeany requirement, butyou
mayshare your knowledge or experiencethat
will make the counseling more interesting and
District Zion
Council Utah National Parks Council
and is qualified to begin working for this merit badge
X
Date
valuable.
Signatureof unitleader
34124A BOY SCOUTS OF AMERICA
2001 BoyScouts of America
03-
#34124A
11
I
COUNSELOR'S RECORD
APPLICANT'S RECORD
Applicant
Name
The applicant has personally appeared beforeme and
demonstrated to mysatisfaction that he has metall
requirements for the(please print)
Communications
Meritbadge
Has given me his completed application for the
Troop
Unit number
Troop, team,crew, ship
David Swenson
Name of counselor
Communications
Merit Badge
9 West 1725 S.
Address of counselor
Communications
Completed on
by
Date
Merit Badge
Washington
City
Zipcode
801-661-3743
Telephone number of counselor
Date completed
Remarks:
Signatureof Counselor
Signature of counselor
Date Completed
Checked and recorded:
Itis suggested that the counselor keep this
record for at least 1 year in case any question
is raised later in regard to this award.
Signatureof Unit Leader
Note to Scout: Retain this copyfor your
permanent records.
Instructions to Counselor:
counselor is registered &approved
• Never meet alone with a Scout.
• Verify all info &merit badge name.
Dato
Initials
Certificate and badge presented
Dato
Applicant will turn in this portion to his unit
leader for record posting.
Instructions to Unit:
•Always meetwith your counselor
• Print your name, address, &ph. #
• Date/initial requirements as done.
• A 2nd counselor can finish card.
• Note each name, address &phone.