MERIT BADGE COUNSELOR APPLICATION PACKET /
Name: Preferred Phone No: ( )
Address: Alternate Phone: ( )
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/ Boy Scouts of America Grand Canyon CouncilMERIT BADGE COUNSELOR APPLICATION PACKET /
City: State Zip Code: Male Female
Birth Date: ______E-mail Address: ______District: ______
If currently registered what is your Scouting position ______and Unit ______
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/ Boy Scouts of America Grand Canyon CouncilMERIT BADGE COUNSELOR APPLICATION PACKET /
To qualify as a merit badge counselor, you must:
Ø Be at least 18 years old
Ø Be proficient in the merit badge subject by vocation or avocation.
Ø Be able to work with Scout-age boys
Ø Be registered with the Boy Scouts of America as a merit badge counselor (position code 42)
Ø Be Youth Protection Trained within the last two years / As a merit badge counselor, I agree to:
Ø Follow the requirements of the merit badge, making no deletions or additions, ensuring that the advancement standards are fair and uniform for all Scouts.
Ø Have another Scout, parent or guardian, relative or friend present at all instructional sessions.
Ø Renew my registration annually if I plan to continue as a merit badge counselor (position code 42) as required by your district.
Is the merit badge subject related to your work? If the merit badge subject is a hobby, do you have a "working knowledge" of the requirements? Do you have any special training or other qualifications for the merit badge subject? (For the Swimming and Lifesaving merit badges, current Safe Swim Defense and CPR certification is required. For the Rowing, Canoeing, Small-boat Sailing, Motorboating and Waterskiing merit badges, current Safety Afloat and CPR certification is required. To serve as a counselor for the Rifle or Shotgun Shooting merit badge, you must have the relevant NRA certification. First Aid Training is highly recommended for aquatics and shooting merit badge counselors. Additional council-approved training may be required for other merit badge subjects (for example, Whitewater merit badge). Please attach copies of all relevant certifications. All required certifications must be maintained and copies submitted as they are renewed. Please see page 4 of this application for details of the required certifications.
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/ Boy Scouts of America Grand Canyon CouncilMERIT BADGE COUNSELOR APPLICATION PACKET /
There is no fee for becoming a merit badge counselor. You need to submit this form and a BSA Adult Leader Application upon initial registration.
Place a check mark next to the merit badge(s) you want to counsel on page 2 of this form.
Check Appropriate Box or Boxes:
I wish to work with all units I wish to work only with ______(Unit Number)
I am currently registered in ______and hold a position of ______
I am not currently registered. My Adult Registration form is attached.
Youth Protection Training Date: (Good for 2 Years) http://olc.scouting.org/info/ypt.html
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MERIT COUNSELOR APPLICATION PACKET
Note: The BSA Adult Application must be attached if you are registering as a merit badge counselor (position code 42) for the first time regardless of any other registrations in any other position or if your registration as a counselor is not current. A copy of the Youth Protection Training card must be attached this to application (without it we cannot complete the process).
Applicant Signature: Date: BSA PID No.
District approval by: Date:
15 American Business / 134 Entrepreneurship / 84 Pioneering (2)17 American Cultures / 7 * Environmental Science / 85 Plant Science
16 American Heritage / 129 * Family Life / 86 Plumbing
121 American Labor / 48 Farm Mechanics / 87 Pottery
18 Animal Science / 49 Fingerprinting / 89 Public Health
132 Archaeology / 50 Fire Safety / 90 Public Speaking
19 Archery / 8 * First Aid / 91 Pulp and Paper
20 Architecture / 51 Fish & Wildlife Management / 93 Radio
21 Art / 52 Fishing / 94 Railroading
22 Astronomy / 136 Fly Fishing / 95 Reading
23 Athletics / 54 Forestry / 96 Reptile & Amphibian Study
127 Automotive Maintenance / 55 Gardening / 123 Rifle Shooting (1) (2)
25 Aviation / 56 Genealogy / 146 Robotics (2)
26 Backpacking / 145 Geocaching / 98 Rowing (1) (2)
27 Basketry / 58 Geology / 12 Safety
29 Bird Study / 59 Golf / 99 Salesmanship
32 Bugling / 122 Graphic Arts / 100 Scholarship
1 * Camping (2) / 61 * Hiking / 143 Scouting Heritage
33 Canoeing (1) (2) / 62 Home Repairs (2) / 101 Sculpture
34 Chemistry / 63 Horsemanship / 138 Scuba Diving (1) (2)
147 Chess / 64 Indian Lore / 124 Shotgun Shooting (1) (2)
126 Cinematography / 65 Insect Study / 103 Skating (2)
2 * Citizenship in the Community / 144 Inventing (2) / 105 Small-Boat Sailing
3 * Citizenship in the Nation / 66 Journalism / 135 Snow Sports (1) (2)
4 * Citizenship in the World / 67 Landscape Architecture / 106 Soil & Water Conservation
133 Climbing (1) (2) / 68 Law / 107 Space Exploration
35 Coin Collecting / 69 Leatherwork / 13 Sports
128 Collections / 9 * Lifesaving (1) (2) / 108 Stamp Collecting
5 * Communications / 71 Mammal Study / 109 Surveying
137 Composite Materials / 130 Medicine / 14 * Swimming (1) (2)
36 Computers / 74 Metalwork (2) / 110 Textile
38 Cooking / 75 Model Design and Building / 111 Theater
131 Crime Prevention / 76 Motorboating / 112 Traffic Safety
39 * Cycling / 77 Music / 113 Truck Transportation
40 Dentistry / 78 Nature / 114 Veterinary Medicine
60 Disabilities Awareness / 24 Nuclear Science / 115 Water Sports (2)
41 Dog Care / 79 Oceanography / 116 Weather
42 Drafting / 80 Orienteering / 148 Welding
43 Electricity / 81 Painting / 125 Whitewater (1) (2)
44 Electronics / 10 * Personal Fitness (2) / 117 Wilderness Survival
6 * Emergency Preparedness (2) / 11 * Personal Management / 118 Wood Carving
45 Energy / 82 Pets / 119 Woodwork
45 Engineering / 83 Photography
Notes: * Eagle Required / (1)Requires special qualifications or certifications / (2)Additional notes to counselors in MB pamphlet
Merit Badge Counselor Applicant’s Name: ______PID#______
New Merit Badge Counselors or Dropped Membership as a registered Merit Badge Counselor must use the following application process:
1. Submit a completed Adult Registration form and Disclosure form (Both are the standard two part registration form).
The only signature required is of the person applying to be the Merit Badge Counselor. It is required by National that a separate application be turned in to register as a Merit Badge Counselor.
Notes:
a. If the Individual on the application wants to register as a Merit Badge Counselor and as a Scout Unit Leader or as a Member of Committee the two additional signatures will be required to approve the Scout Unit Position. With two positions being applied for it is required to have a copy to process two separate applications.
b. If the applicant is already approved and registered in a unit as a leader or as Member of Committee, another adult application is still required be filled out and turned in to register as a Merit Badge Counselor.
The Merit Badge registration is good for the current year. Annual registration starts in March and drops the end of February. Please check with your District Executive to know if your leaders are currently registered as Merit badge counselors.
2. Submit a copy of the Youth Protection Card (always required to be turned in with every adult application)
Note:
Web site for Youth Protection training is http://olc.scouting.org/info/ypt.html
Click on “New to MyScouting” and create an account. Reminder; when it asked for you name to enter it the same way that is on your application. Record your user name and password because the training is good for 2 years.
3. Submit the Merit Badge Counselor Application form
Notes:
a. If the applicant is already registered as a Merit Badge Counselor for the current year and would like to update or add additional merit badges they would like to teach; this form can be submitted without the Adult registration form.
Useful web site for counselor (not endorsed by BSA): http://www.meritbadge.org/
Worksheet sites: http://meritbadge.org/wiki/index.php/Worksheets
REQUIRED CERTIFICATIONS
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MERIT COUNSELOR APPLICATION PACKET
General Supervision Requirements:
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MERIT COUNSELOR APPLICATION PACKET
Merit Badge involving Swimming and watercraft (all)
1. BSA Safe Swim Defense as per activity
2. BSA Safety Afloat as per activity
3. mature and conscientious adults at least 21 years old
Merit Badge involving CPR Instruction,
1. Must be taught by certified instructors currently trained by a nationally certified provider.
The following Merit Badges have special qualifications or certifications:
Canoeing,
1. BSA Aquatics Instructor or Canoeing Instructor certification from the American Canoe Association, American Red Cross, or equivalent; OR
2. Local councils may approve individuals previously certified as such, or trained by an instructor so qualified.
Climbing, (all)
1. Mature and conscientious adult at least 21 years old
2. BASE climbing director or instructor
3. Certification in First Aid/CPR/AED from the American Red Cross (or equivalent).
Lifesaving (all)
1. Mature and conscientious adults at least 21 years old
2. Certification in Red Cross First Aid/CPR/AED or equivalent
3. BASE Lifeguard or Aquatics Instructor or equivalent.
Rifle Shooting (must have one of the following depending on the firearm being used)
1. Certification as BASE National Camping School (NCS) shooting sports director, or National Rifle Association (NRA) Rifle Shooting Instructor or Coach.
2. Muzzleloaders must be supervised by an NCS shooting sports director or NRA/National Muzzleloader Rifle Association (NMLRA)–certified Muzzleloader firearms instructor.
3. NRA-certified Range Safety Officer (RSO).
4. Comply with the policies as outlined in the Guide to Safe Scouting and the BSA National Shooting Sports Manual, No. 30931.
Rowing
1. BSA Aquatics Instructor certification or equivalent; OR
2. Local councils may approve individuals previously certified as such, or trained by an instructor so qualified.
Scuba Diving
1. Trained and sanctioned by one of the following agencies: Professional Association of Diving Instructors, National Association of Underwater Instructors, Scuba Schools International, International Diving Educators Association, Professional Diving Instructors Corporation, or Scuba Diving International, or be a member of the World Recreational Scuba Training Council.
Shotgun Shooting (must have one of the following depending on the firearm being used)
1. Certified NCS shooting sports director
2. NRA Shotgun Instructor or Coach.
3. That involving muzzle-loading shotguns must be supervised by an NCS shooting sports director or NRA/NMLRA certified muzzle-loading shotgun instructor.
4. Shooting must be supervised by an NRA-certified Range Safety Officer.
5. Comply with the policies as outlined in the Guide to Safe Scouting and the BSA National Shooting Sports Manual, No. 30931.
Snow Sports
1. Mature and conscientious adult 21 years or older
2. Comply with BSA Winter Sports Safety as defined in the Guide to Safe Scouting
Swimming
1. BSA Safe Swim Defense, and
2. BSA Safety Afloat
Whitewater
1. Must be designated by the local council
2. Certified as whitewater canoeing or kayaking instructors by the American Canoe Association or have equivalent certifications, training, or expertise.
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