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Mountain UT 84005
City/state/zip*__Eagle
_______________________________
Other phone__________________________
Home
Cell
Work
tyler.collette@gmail.com
Email address*_____________________________________________
I do not have email.
District________________________________ Unit:
Troop
Team
Crew
29
Age_________
*Required field. Primary phone and email address indicate how Scouts should contact you.
Add (A)
Drop (D)
For each merit badge, list qualification(s) that support your request.
Qualifications could include college degrees, formal training certificates,
positions held, and specific life experiences.
1.
Programming
2.
Computers
See above
3.
Environmental Science
4.
Family Life
5.
Shotgun Shooting
6.
7.
8.
A = Adding a new merit badge that you will counsel to the roster.
D = Removing your name from the roster for this merit badge.
Council Approval:
Name (print)______________________________
Position__________________________________
I plan to serve as a merit badge counselor for this event or outside organization:_______________________________________
Signature__________________________________________________________________ Date____________________________
Effective counseling
34405WEB
2013 Printing