ALLOHAK COUNCIL BOY SCOUTS OF AMERICA
MERIT BADGE COUNSELOR APPLICATION
UNIT #________________ DISTRICT__________________________________________(NA if not affiliated with a unit)
(Please print or type the following information. Please show your full name (no nicknames)
NAME:______________________________________________ BIRTH DATE______________________
HOME E-MAIL:______________________________WORK E-MAIL:_____________________________
SOCIAL SECURITY NUMBER_____________________________________________________________
PHONE (Home)____________________________ (Work)_______________________________________(Circle the one you want used for the boys to contact you)
I wish only to work with only _________ I wish to work with all units_______________(Unit#)
All Merit Badge Counselors must be a registered member of the Boy Scouts of America. Even if you are already
registered in another position and this is your first time registering as a Merit Badge Counselor, you must complete
a BSA Adult Application form with the Position Code of 42 (for Merit Badge Counselor). Merit Badge Counse-
lors registration will end on the last day of each year and will not be renewed without your written authori-
zation.By signing the back of this form, you agree to the following standards:
As a Merit Badge Counselor, I will:Examine the latest revision of the BSA Merit Badge pamphlet for each Merit Badge I select on the list
attached to this.
Require the Scout to complete all and only all of the requirements.
Counsel the Scout to:
A. Keep his appointment
B. Be in uniform
C. Bring a legibly filled out Merit Badge Application card signed in ink by his unit leader or designee.
D. In keeping with BSA Youth Protection Guidelines, bring an adult to every counseling session we
Notify the Allohak Council Registrar when I no longer want to serve as a Merit Badge Counselor,
Allow my name and phone number to be published on the Allohak webiste so that I may be contacted by
Scouts wishing to take a Merit Badge.
Allohak Council - 1340 Juliana Street - Parkersburg, WV 26101
304.422.4507 - 800.654.5272
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 recommend that no counselor counsel for more than six (6) merit badge subjects.
Please list your qualification(s) for the Merit Badge(s) subject you have checked (add additional sheets if needed)
As a Merit Basdge Counselor, I agree to follow the standards listed on the previous page.
Bugling (See Music)
Fish & Wildlife
Mining in Society
Pulp & Paper
Reptile & Amphib
Search & Rescue
Signs, Signals & Codes
Small Boat Sailing
Soil & Water Conserv
As of 7/24/14