Merit Badge Counselor Information Form
Boy Scouts of America Merit Badge Counselor Information (Please type or print)
Name ___________________________ Age ______ Business phone (___)____________
Address __________________________________ Home phone (___)_________________
City __________________________________ State __________ Zip code __________
|To qualify as a merit badge counselor, you must
||As a merit badge counselor, I agree to
|List merit badge subjects here.||Is this subject in line with your job, business, or profession? If yes, give brief information on the reverse side.||Do you follow this subject as a hobby, having more than a "working knowledge" of the requirements? If yes, give brief information on the reverse side.||If not, do you have any special training or other qualifications for this subject? If yes, give brief information on the reverse side.|
__ I wish to work only with unit number ________________.
__ I wish to work with all units.
Signature _________________________________________________ Date ___________________
Note: The BSA Adult Registration Application must be attached.
Council approval by _________________________________________ Date ___________________