The applicant has personally appeared before me and
demonstrated to my satisfaction that all requirements
have been met for the (please print)
| Merit Badge |
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| Counselor |
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| Address |
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| |
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| Telephone number |
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| Email address |
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Signature |
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Date |
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| Checked and recorded: |
| Date certificate and badge presented: |
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Applicant will turn this portion to his unit leader
for record posting.
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APPLICANT’S RECORD
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| Name |
Sydney Mace |
| has given me this completed application for the |
| Merit Badge |
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| Signed On |
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| Signature of counselor |
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| Signature of unit leader |
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NOTE TO SCOUT, VENTURER, OR SEA SCOUT:
Retain this copy for your permanent record.
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COUNSELOR’S RECORD
|
| Applicant |
Sydney Mace |
| Unit Number |
Troop 702 |
| Merit Badge |
|
| Date Signed |
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Remarks: |
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It is suggested that the counselor keep this
record in case any question is raised later in
regard to this award.
|