OHIO ELKS ASSOCIATION

GIRL SCOUT & BOY SCOUT
MERIT AWARD APPLICATION

(PLEASE TYPE OR PRINT CLEARLY)
NAME:________________ ____________________ ____________ ______________
  last first middle initial application date
ADDRESS:_____________________________ _________________ ______________
  street city state & zip code
Girl Scout Boy Scout
____________   ___/___/___ ____________
Troop number BIRTH DATE:
 month/day/year home phone
MAXIMUM AGE 17 years old (eligibility determined as of April 1 of each current year)
PARENT / GUARDIAN NAME:_____________________________________________
SCHOOL:______________________ _________ ___________________ __________
  name grade principal / teacher name phone #
LOCAL COUNCIL:_______________________________________________________
  name
  address  
_______________ _______________________________________ _______________
  phone
 contact person   e-mail address
PLEASE ATTACH ON A SEPARATE SHEET DETAILED INFORMATION WITH EACH TOPIC. INCLUDE YEARS
OR NUMBER OF TIMES YOU PARTICIPATED WITH EACH PROGRAM
TOPICS
 
SCOUTING EXPERIENCE
 
ACTIVITIES
 
COMMUNITY PARTCIPATION
 
PLEASE INCLUDE THE FOLLOWING INFORMATION WITH EACH APPLICATION:
1) Applicant Essay ~ how does scouting effect your personal and family life?
2) Letter of Recommendation – either by Scout Leader, Advisor or Council Representative ( with phone # )
3) Letter of Recommendation – (optional) School Principal or Teacher ( with phone # )
 
__________________________ ___________________ ________________________
applicant signature   social security #   parent / guardian signature
______________________   ______________________
scout leader / advisor signature   local council signature

Mail application packet to Local Council Office
 
Reproduction of this form is permissible
 
Jean A. Zink, State Chairman Youth Activities Committee Ohio ELKS Association
 
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