______________________________________________ ______________________________________________
REQUIREMENT 4. While a Life Scout, serve actively in your unit for a period of six
Venturing crew. President, vice president, secretary, historian, den chief, treasurer,
months in one or more of the following positions of responsibility. List only those
guide, quartermaster, chaplain aide, outdoor ethics guide
positions served after Life board of review date.
Sea Scout ship. Boatswain, boatswain’s mate, purser, yeoman, storekeeper, crew
Scout troop. Patrol leader, assistant senior patrol leader, senior patrol leader, troop
leader, media specialist, specialist, den chief, chaplain aide
guide, Order of the Arrow troop representative, den chief, scribe, librarian, historian,
Lone Scout: Leadership responsibility in your school, religious organization, or club,
quartermaster, junior assistant Scoutmaster, chaplain aide, instructor, webmaster,
or elsewhere in your community
outdoor ethics guide
Date of Life Scout
board of review
Month Day Year
Position
_________________________________________________________________
TO
Month Day Year Month Day Year
FROM
Position
_________________________________________________________________
TO
Month Day Year Month Day Year
FROM
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 must benefit an organization other than the Boy Scouts of America.) A project proposal must be approved by the organization benefiting from the effort, your unit leader and
unit committee, and the council or district before you start. You must use the Eagle Scout Service Project Workbook, No. 512-927, in meeting this requirement.
Project name: _____________________________________________________________
Date project finished
Grand total of hours: __________ (from Eagle Scout Service Project Workbook—for statistical purposes only)
Month Day Year
REQUIREMENT 6. While a Life Scout, participate in a unit leader conference.
Date conference was held
Month Day Year
CERTIFICATION BY APPLICANT. On my honor as a Scout, Venturer, or Sea Scout all statements on this application are true and correct.
All requirements, with the exception of my board of review, were completed prior to my 18th birthday.*
In preparation for your board of review, prepare and attach to your Eagle Scout Rank 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.
Signature of applicant
_______________________________________________ Telephone__________________
Date
Month Day Year
*Or the date established by an extension of time granted by the National Council (see the Guide to Advancement, section 9.0.4.0.). The
completion date does not apply to Scouts registered beyond the age of eligibility as provided for in the Guide to Advancement, section 10.0.0.0.
UNIT APPROVAL (personal signatures required)
Signature of unit leader______________ ___________________________ Telephone__________________
Date
Scoutmaster, Advisor, or Skipper
Month Day Year
Signature of unit committee chair ____________________________________________
Telephone__________________
Date
Month Day Year
BSA LOCAL COUNCIL VERIFICATION. 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
REQUIREMENT 7. Successfully complete your board of review for the Eagle Scout rank.
The applicant appeared before the Eagle Scout board of review on this date, and this application was approved.
Date
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 the Guide to Advancement, 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.
NATIONAL EAGLE SCOUT ASSOCIATION. As an Eagle Scout, you may now join the National Eagle Scout Association, a fellowship of the top
achievers of the Boy Scouts of America. Join TODAY at www.NESA.org.
NESA membership fees go toward the production of the award-winning quarterly Eagle’s Call, networking opportunities for Eagle Scouts, and support
of NESA’s many programs such as providing college scholarships.
Lifetime NESA members are eligible to purchase the NESA life member square knot at their local Scout shops. It is the same as the Eagle Scout knot,
but with a silver border, and it replaces the Eagle square knot on the uniform.
Please use the most current application found at www.scouting.org/media/forms.aspx.
January 2020 Printing
512-728
