FILIPINO-AMERICAN CONVOCATION OF EAGLE SCOUTS

(The Official USA Chapter of the Eagle Scout Organization of the Philippines)

P.O. Box 4129, Redondo Beach, California 90278

Membership Application

INSTRUCTIONS. Complete this application for in its entirety. Dates requested on the document must be in MMDDYYYY format. February 1, 2011 should be written as 02012011. A U.S. person for our purposes is a citizen or a legal resident of the United States. A person who holds a valid work visa or permit is also considered a U.S. person for membership purposes. Filipino heritage is determined by Filipino citizenship, nationality, or ethnicity. Mail completed forms to the address above including all requested attachments.

What was the award you received? Eagle Scout (BSP) Eagle Scout (BSA) Scout Citizen Rizal Scout
Are you a U.S. person? Yes No
Are you of Filipino heritage? Yes No
What was your local council when you received your award?
Date award was received
Date of Birth

Personal Details

Name (First, Middle, Last) / E-mail address
Address / Apartment Number
City / State / Zip Code / Province / Country
Home Phone / Work Phone / Mobile Phone

Educational Background

Undergraduate Degree / College or University / Degree Completed and Major
Masters Degree / College or University / Degree Completed and Area of Focus
Doctorate Degree / College or University / Degree Completed and Area of Focus
Would you be willing to provide letters of recommendations to fellow Eagle Scouts? Yes No

Professional Information

Employment Status
Employed Self-Employed Retired / Company Name / Position or Title
Would you be willing to refer or share job openings to others (particularly Eagle Scouts)? Yes No

Current Scouting Information

Are you a BSP Member? Yes No / BSP Local Council / BSP Position
Are you a BSA Member? Yes No / BSA Local Council / BSA Position
Would you be willing to assist and guide others to be actively involved with Scouting? Yes No

PROVIDE COPIES: (1) award credentials; (2) picture identification; (3) BSP Eagles: proof of U.S. person; and (4) BSA Eagles: proof of Filipino heritage. A U.S. driver license is sufficient to fulfill both #2 and #3. A statement certifying and how that you are of Filipino descent is sufficient to fulfill #4. You may provide other documents.

F01 REV. (01/2011)