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Heart of America Council Boy Scouts of America
Staack:mbcapp2015 9/22/2014
MERIT BADGE COUNSELOR APPLICATION
YEAR ________
Renew _______ *As a New Counselor ______ I have attached an Adult Application as required by National BSA.
Please print or type the following information. List your name as it shows on your BSA registration.
Name ________________________________________________ Unit# _________ District _____________________
Address __________________________________________________ Home Phone ( ) ____________________
City ________________________________ State ________ Zip ____________Date of Birth ____________________
Occupation ________________________________ E-mail Address _________________________________________
I am currently registered with the BSA as (position) _______________________________________________________
Are you an Eagle Scout? Yes __________ No __________ If yes, what is your Eagle Rank date? _______________
All Merit Badge Counselors must be registered members of the Boy Scouts of America. Even if you are already registered in another position, you must still complete a BSA Adult Application (#28-501F) form with the Position Code “42” (no charge). Note: Effective April 1, 2003, the Social Security Number on all adults is required by the National Boy Scouts of America. Effective June 1, 2010, all adults are required to provide proof of Youth Protection
Training with their applications.
To qualify as a merit badge counselor you must: 1. Be at least 18 years old. 2. Be proficient in the merit badge subject by vocation or avocation.
3. Be able to work with Scout-age boys. 4. Be registered as a Merit Badge Counselor with the Boy Scouts of America. (Submit Adult BSA Application with
your Merit Badge Counselor Application.)
5. Attend Merit Badge Counselor Orientation. I attended Merit Badge Counselor Orientation on: Date______________
6. Attend Youth Protection Training – Please attach a copy of your card. I received Youth Protection Training on: Date ______________
The Boy Scout Handbook instructs the Scout to meet with you, before he starts to establish a mutual understanding of the requirements and his commitment to complete those requirements.
By signing the back of this form, you agree to the following standards:
As a Merit Badge Counselor, I will: 1. Examine the latest revision of the BSA Merit Badge pamphlet of each Merit Badge I select on the reverse side of
this form. 2. Require the Scout to complete all and only all of the requirements.
3. Counsel the Scout to: a. Keep his appointment. b. Be in uniform.
c. Bring a legible filled out Merit Badge Card signed in ink by his unit leader or designee. d. In keeping with BSA Youth Protection Guidelines, have multiple Scouts/Adults at every counseling session.
4. Notify the District Advancement Chairman if I can’t serve as a Merit Badge Counselor any longer this year. 5. Renew my Merit Badge Counselor application every year. If I let my membership lapse I will complete a new
BSA Adult Application for Merit Badge Counseling.
MERIT BADGE SUBJECTS
To provide boys an opportunity to meet and interact with as many different qualified adults as possible during the Scouting years, it is recommended that no counselor counsel for more than six (6) merit badge subjects.
���� Check the Merit Badges that you wish to counsel.
15 ____ American Business
17 ____ American Cultures
16 ____ American Heritage
121 ____ American Labor
18 ____ Animal Science
132 ____ Archaeology
19 ____ Archery
20 ____ Architecture
21 ____ Art
22 ____ Astronomy
23 ____ Athletics
127 ____ Automotive Maintenance
25 ____ Aviation
26 ____ Backpacking
27 ____ Basketry
29 ____ Bird Study
32 ____ Bugling
01 ____ Camping*
33 ____ Canoeing+
34 ____ Chemistry
147 ____Chess
126 ____Cinematography
02 ____ Citizenship – Community*
03 ____ Citizenship – Nation*
04 ____ Citizenship – World*
133 ____ Climbing
35 ____ Coin Collecting
128 ____ Collections
05 ____ Communication*
137 ____ Composite Materials
38 ____ Cooking*
131 ____ Crime Prevention
39 ____ Cycling*^
40 ____ Dentistry
60 ____ Disabilities Awareness
41 ____ Dog Care
42 ____ Drafting
43 ____ Electricity
44 ____ Electronics
06 ____ Emergency Prep*#
45 ____ Energy
46 ____ Engineering
134 ____ Entrepreneurship
07 ____ Environmental Science*%
129 ____ Family Life*
48 ____ Farm Mechanics
49 ____ Fingerprinting
50 ____ Fire Safety
08 ____ First Aid*
51 ____ Fish and Wildlife Mgmt.
52 ____ Fishing
136 ____ Fly Fishing
54 ____ Forestry
151 ____Game Design
55 ____ Gardening
56 ____ Genealogy
145 ____Geocaching
58 ____ Geology
59 ____ Golf
122 ____ Graphic Arts
61 ____ Hiking*^
62 ____ Home Repairs
63 ____ Horsemanship
64 ____ Indian Lore
65 ____ Insect Study
144 ____Inventing
66 ____ Journalism
140 ____Kayaking
67 ____ Landscape Architecture
68 ____ Law
69 ____ Leatherwork
09 ____ Lifesaving*#+
71 ____ Mammal Study
130 ____ Medicine
74 ____ Metalwork
155 ____Mining in Society
75 ____ Model Design & Building
76 ____ Motor Boating
156 ____ Movie Making
77 ____ Music
78 ____ Nature
24 ____ Nuclear Science
79 ____ Oceanography
80 ____ Orienteering
81 ____ Painting
10 ____ Personal Fitness*
11 ____ Personal Mgmt*
82 ____ Pets
83 ____ Photography
84 ____ Pioneering
85 ____ Plant Science
86 ____ Plumbing
87 ____ Pottery
153 ____Programming
89 ____ Public Health
90 ____ Public Speaking
91 ____ Pulp and Paper
93 ____ Radio
94 ____ Railroading
95 ____ Reading
96 ____ Reptile and Amp. Study
123 ____ Rifle Shooting
146 ____ Robotics
98 ____ Rowing
12 ____ Safety
99 ____ Salesmanship
100 ____ Scholarship
143 ____Scouting Heritage
138 ____Scuba Diving
101 ____ Sculpture
150 ____Search & Rescue
124 ____ Shotgun Shooting
103 ____ Skating
105 ____ Small Boat Sailing
135 ____ Snow Sports
106 ____ Soil & Water Cons.
107 ____ Space Exploration
13 ____ Sports
108 ____ Stamp Collecting
109 ____ Surveying
152 ____Sustainability*%
14 ____ Swimming*^+
110 ____ Textile
111 ____ Theater
112 ____ Traffic Safety
113 ____ Truck Transportation
114 ____ Veterinary Medicine
115 ____ Water Sports+
116 ____ Weather
148 ____Welding
125 ____ Whitewater+
117 ____ Wilderness Survival
118 ____ Wood Carving
119 ____ Woodwork
* This badge is required for the Eagle Scout Rank. ^ Only one of these badges (Swimming, Hiking, or Cycling) can be used as a required M.B. for the Eagle Scout Rank.
# Only one of these badges (Emergency Preparedness or Lifesaving) can be used as a required M.B. for the Eagle Scout Rank. % Only one of these badges (Environmental Science or Sustainability) can be used as a required M.B. for the Eagle Scout Rank. + Water Activities must meet the requirements of BSA Safe Swim Defense (See BSA Guide to Safe Scouting).
Please list your qualifications for the subjects you have checked: ______________________________________________________________
_________________________________________________________________________________________________________________________
As Merit Badge Counselor, I agree to follow the standards as listed on the first of this application. Please indicate by checking the box which applies, sign and return to the address below:
I do not wish to be included in the Council Website.
I give my permission to print my name, address, phone number and post on the Council website interactive directory of Merit Badge Counselors at www.hoac-bsa.org
Signature: ____________________________________________ Date: _______________ Unit #:_______ District:_____________
If you would like to delete or add merit badges to your list after February 1, please email [email protected].
DISTRICT ACTION
APPROVED AND VERIFIED BY: (INITIAL AND DATE)
DISTRICT DIRECTOR/EXEC. _______________________
DISTRICT ADVANCEMENT CHAIR ____________________
SCOUTNET ACCESS
Return completed application & accompanying documents to:
Merit Badge Counselor Application Heart of America Council, BSA 10210 Holmes Road Kansas City, MO 64131
