EAGLE SCOUT RANK APPLICATION

FOR COUNCIL USE ONLY

COUNCIL NO. TYPE OF UNIT

TO THE EAGLE SCOUT RANK APPLICANT. This application is to be completed after you
REGION NATIONAL NO.
have completed all requirements for the Eagle Scout rank. Print in ink or type all informa-
tion. List the month, day, and year for all dates. When using computer date blocks list the C, N, S, W
date: July 8, 1970, as 07 (for July) 08 (for day) 70 (for year). When you have completed this
application, sign it and submit it to your unit leader. NAME ON OFFICIAL REGISTRATION

PID NO. (REQUIRED)

LIST YOUR FULL LEGAL NAME (UP TO 30 CHARACTERS ONLY).

Month Day Year

__________________________________________________ Date joined a Boy Scout troop
Street or R.F.D. Address
Date became a Varsity Scout
__________________________________________________ Date became a Venturer
City, state, zip
Date of First Class Scout board of review
__________________________________________________ Date of Star Scout board of review
Telephone (Including area code)
Were you a Cub Scout? ■ Yes ■ No
__________________________________________________
Troop, Team, Crew, or Ship Local No. Were you a Webelos Scout? ■ Yes ■ No
Did you earn the Arrow of Light Award? ■ Yes ■ No
__________________________________________________
City, state, zip Had you completed fifth grade upon joining? ■ Yes ■ No

AGE REQUIREMENT ELIGIBILITY. Merit badges, badges of rank, and Eagle Palms may be earned by a registered Boy Scout, Varsity Scout, or Venturer. He may earn these
awards until his 18th birthday. Any Venturer who achieved the First Class rank as a Boy Scout in a troop or Varsity Scout in a team may continue working for the Star, Life,
and Eagle Scout ranks and Eagle Palms while registered as a Venturer up to his 18th birthday. Scouts and Venturers who have completed all requirements prior to their
18th birthday may be reviewed within three months after that date with no explanation. Boards of review conducted between three and six months after the candidate’s
18th birthday must be preapproved by the local council. A statement by an adult explaining the reason for the delay must be attached to the Eagle Scout Rank Application
when it is submitted to the Eagle Scout Service. The Boy Scout Division at the national office must be contacted for procedures to follow if a board of review is to be
conducted more than six months after a candidate’s 18th birthday.
A Scout or Venturer with a disability may work toward rank advancement after he is 18 years of
age. See Advancement Committee Policies and Procedures for details. Date of birth
Month Day Year

REQUIREMENT 1. Be active in your troop, team, crew, or ship for a period of at least six months Date of Life Scout
after you have achieved the rank of Life Scout. board of review
Month Day Year

REQUIREMENT 2. Demonstrate that you live by the principles of the Scout Oath and Law in your daily life. List the names of individuals who know you personally and would
be willing to provide a recommendation on your behalf.
Name Address Telephone E-mail

Parents/guardians ___________________ ___________________________ _______________ __________________

Religious ___________________ ___________________________ _______________ __________________
Educational ___________________ ___________________________ _______________ __________________
Employer (if any) ___________________ ___________________________ _______________ __________________
Two other references ___________________ ___________________________ _______________ __________________
___________________ ___________________________ _______________ __________________
REQUIREMENT 3. Earn a total of 21 merit badges (required badges are listed). List the month, day, and year the merit badge was earned.

DATE UNIT DATE UNIT DATE UNIT

MERIT BADGE EARNED NO. MERIT BADGE EARNED NO. MERIT BADGE EARNED NO.
1 CAMPING 8 FIRST AID 15

2 CITIZENSHIP IN *9 CYCLING OR HIKING 16

THE COMMUNITY OR SWIMMING
3 CITIZENSHIP IN 10 PERSONAL 17
THE NATION MANAGEMENT
4 CITIZENSHIP IN 11 PERSONAL FITNESS 18
THE WORLD
5 COMMUNICATIONS 12 FAMILY LIFE 19

*6 EMERGENCY PREPARED- 13 20
NESS OR LIFESAVING
7 ENVIRONMENTAL 14 21
SCIENCE
*Cross out badges not earned. If a crossed-out badge was earned, it may be reentered in 13 through 21.
Four of these required merit badges were earned for the Star Scout rank and three more were earned for the Life Scout rank.
REQUIREMENT 4. While a Life Scout, serve actively for a period of six months in Venturing crew/ship. President, vice president, secretary, treasurer, den
one or more of the following positions of responsibility. List only those positions chief, quartermaster, historian, guide, boatswain, boatswain’s mate, yeoman,
served after Life board of review date. purser, storekeeper
Boy Scout troop. Patrol leader, Venture patrol leader, assistant senior patrol leader, se- Lone Scout: Leadership responsibility in his school, religious organization, club,
nior patrol leader, troop guide, Order of the Arrow troop representative, den chief, scribe, or elsewhere in his community
librarian, historian, quartermaster, junior assistant Scoutmaster, chaplain aide, instructor;
(effective Jan. 1, 2010) Webmaster and Leave No Trace trainer
Varsity Scout team. Captain, cocaptain, program manager, squad leader, team
secretary, Order of the Arrow team representative, librarian, historian, quartermaster, Date of Life Scout
chaplain aide, instructor, den chief board of review
Month Day Year

Position _________________________________________________________ FROM TO

Month Day Year Month Day Year

Position _________________________________________________________ FROM TO

Month Day Year Month Day Year

REQUIREMENT 5. While a Life Scout, plan, develop, and give leadership to others in a service project helpful to any religious institution, any school, or your community.
The project plan must be approved by your Scoutmaster and troop committee, by the council or district, and by the organization benefiting from the effort before you start.
You must use the Eagle Scout Leadership Service Project Workbook, No. 512-927, in meeting this requirement.

Project name: _____________________________________________________________ Date of final signature

Month Day Year
Grand total of hours: __________ (from page 10 of Eagle Scout Leadership Project Workbook—for statistical purposes only)
REQUIREMENT 6. Take part in a Scoutmaster conference (with Scoutmaster, Coach, or Advisor). Attach to this application a statement of your ambitions and life purpose and
a listing of positions held in your religious institution, school, camp, community, or other organizations during which you demonstrated leadership skills. Include honors and
awards received during this service.

Date conference was held

Month Day Year

CERTIFICATION BY APPLICANT. On my honor as a Scout/Venturer, all statements on this application are true and correct. All requirements were completed prior to my
18th birthday.

Signature of applicant ________________________________________ Telephone__________________ Date

Month Day Year

UNIT APPROVAL (personal signatures required)

Signature of unit leader ___________________________________ Telephone__________________ Date

Scoutmaster, Coach, or Advisor Month Day Year

Signature of unit committee chair ____________________________________ Telephone__________________ Date

Month Day Year

BSA LOCAL COUNCIL CERTIFICATION. According to the records of this council, the applicant is a registered member of this unit and this application is approved as accurate.

Signed __________________________________ Position_________________________________ Date

Month Day Year

Successfully complete an Eagle Scout Board of Review. The applicant appeared before the Eagle Scout board of review on this date, and this application was approved.

Review date This date will be used on the Eagle Scout credentials.
Month Day Year

_________________________________________ _________________________________________
Signature of Eagle Scout board of review chair Signature of council/district board representative (if applicable)

I certify that all procedures, as outlined in Advancement Committee Policies and Procedures, have been followed. I approve this application.

Scout Executive _________________________________________________________________________ Date

Month Day Year

Presentation of the rank may not be made until the Eagle Scout credentials are received by
the BSA local council. EAGLE SCOUT SERVICE VALIDATION

NATIONAL EAGLE SCOUT ASSOCIATION. The National Eagle Scout

Association is a fellowship of men who have achieved the Eagle Scout rank.
Membership embraces the top achievers of the Boy Scouts of America.
Benefits include a subscription to Eagletter. The journal keeps NESA members
informed on Scouting in general and Eagle Scouting in particular.

Applications are available at your local council service center.

Regular five-year memberships are $25. Life memberships are $180.

EDITIONS OF THIS APPLICATION PREVIOUS TO THE 2009 REVISION SHOULD NOT BE USED.
512-728

7 30176 30676 6
2009 Printing