August 2017

EAGLE SCOUT PALM APPLICATION – BOY SCOUTS OF AMERICA

(SUBMIT TO LOCAL COUNCIL – DO NOT SUBMIT TO NATIONAL OFFICE)

The Boy Scout advancement plan of the BSA is for registered members from their joining until their 18th birthday. Members who have completed all requirements for advancement before their 18th birthday may be recognized after that date.

Troop | Team | Crew | Unit No. _______ | Date: _____________ City: _________________________________________ | State: ________

District: ________________________ | County: ____________________

Expiration date of Unit: _______ /_______ / _______

APPLICATION TO LOCAL COUNCIL Name: ________________________________________ Address: ______________________________________ City, State, Zip: _________________________________ The required 3 months have elapsed since I became an Eagle Scout OR received my __________ Palm. Now that I have completed the five (5) requirements* listed below, I respectfully submit my application for the award of the: Bronze Palm | Gold Palm | Silver Palm

I became an Eagle Scout on: ______ / ______ / ______ I was awarded the Bronze Palm on: ______ / ______ / ______ (5 merit badges) I was awarded the Gold Palm on: ______ / ______ / ______ (10 merit badges) I was awarded the Silver Palm on: ______ / ______ / ______ (15 merit badges) * The merit badges listed below may have been earned at any time since joining.

RECORD OF MERIT BADGES Unit where registered when awarded the merit badge

Merit Badge Number Town State Date

Unit Leader Approval Signature: __________________________________________ Date: ______ / _____ / _____

ACTION OF LOCAL COUNCIL

Approved by: _____________________________________________ Date: _____ / _____ / _____ LOCAL COUNCIL RECORD

1.Checked:

2. Certificate prepared: 3. Award Made:

4. Posted to District Advancement Summary:

5. Filed in Unit history folder:

You may wear only the proper combination of Palms for the merit badges you have earned.

August 2017

INFORMATION & PROCEDURES Effective August 1, 2017, BSA changed the guidelines for awarding Eagle Palms. You will find the new guideline on the BSA’s website at: http://www.scouting.org/filestore/boyscouts/pdf/eagle_palms_2017.pdf The procedure for requesting Eagle Palm awards is: 1 For each five (5) merit badges earned, complete the Eagle Scout Palm Application form. 2 For Scouts earning Eagle rank after August 1, 2017, if you have multiples of five merit badges at the time of

your Eagle rank advancement, you will need to submit a form for each group of five merit badges. 3 Submit the form to Council along with a copy of your Eagle Rank Application form showing the merit badges

you listed for your Eagle rank. 4 If you already have a Palm award – or multiples – include a copy of those submissions. This will assist Council

in their verification process.

Eagle Palm Combinations

Merit

Bad

ges

Bronz

e Palm

s

Gold P

alms

Silve

r Palm

s

Merit

Bad

ges

Bronz

e Palm

s

Gold P

alms

Silve

r Palm

s

26 1 76 1 3

31 1 81 4

36 1 86 1 4

41 1 1 91 1 4

46 1 1 96 5

51 2 101 1 5

56 1 2 106 1 5

61 1 2 111 6

66 3 116 1 6

71 1 3 121 1 6