ADULT APPLICATION
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02/2020
Youth Protection Training
All adult applicants are required to take
this training in order to complete the adult
application process. Go to my.Scouting.org
to create an account and take the
training online or contact your local council
for classroom training. Include a copy of your
completion certicate with this application.
Mission
The mission of the BSA is to prepare
young people to make ethical and
moral choices over their lifetimes
by instilling in them the values
of the Scout Oath and Scout Law.
Your participation in the BSA can help youth become better citizens.
Adult leaders serve as important role models for youth in the BSA and this application aids the chartered organization
in selecting qualied adult volunteer leaders.
Excerpt From the Declaration of Religious Principle
The BSA maintains that no member can grow into the best kind of citizen without recognizing an obligation to God and, therefore, recognizes
the religious element in the training of the member, but it is absolutely nonsectarian in its attitude toward that religious training. Its policy
is that the home and organization or group with which the member is connected shall give denite attention to religious life. Only persons
willing to subscribe to these precepts from the Declaration of Religious Principle and the Bylaws of the BSA shall be entitled to register.
Criminal Background Check*
In order to complete the adult application
process, you will need to review the
different disclosures that have been
separately provided to you. The separate
authorization form must be signed and
returned when you submit your application.
*The three different background check forms must be torn off and each separately given to the applicant.
SKU 655528
524-501 2020 Printing
Leader Requirements
The BSA is open to all who meet the requirements, and leaders are selected based on individual merit.
Adult leaders must possess the moral, educational, and emotional qualities that the BSA deems
necessary for positive leadership to youth. They must also:
Abide by the Scout Oath, Scout Law, and Scouter Code of Conduct. The Scouter Code of Conduct can
be found at www.scouting.org/health-and-safety/gss/bsa-scouter-code-of-conduct/.
Subscribe to the precepts of the Declaration of Religious Principle.
Reside within the USA or a U.S. territory, or be a U.S. citizen residing outside the USA.
Be 21 years of age or older for primary leadership positions.
Be 18 years of age or older for assistant leadership positions.
Complete Youth Protection training (YPT) before application is processed and renew training
as required by going to my.Scouting.org and creating an account.
Review the disclosure information related to the BSAs background check process and complete and
sign a Background Check Authorization form.
Take leader position-specic training at my.Scouting.org. Classroom training may also be available
through your local council.
APPROVAL REQUIRED—UNIT ADULTS
Chartered organization head or chartered organization representative. The chartered organization
representative is approved by the head of the chartered organization. All other adult leader
applications must be accepted and approved by the head of the chartered organization or the
chartered organization representative.
APPROVAL REQUIRED—COUNCIL and DISTRICT ADULTS
Scout executive or designee must accept and approve all council and district adults.
Scout executive or designee must approve any adults who answer “yes” to any Additional
Information question.
The adult leader application process will not be complete until Youth Protection training has been
completed and a criminal background check has been obtained.
Health information. You should inform your unit leadership of any condition that might limit your
participation. Before participating in activities with your unit, please ll out the Annual Health and
Medical Record, No. 680-001, found on www.scouting.org/forms and provide it to your unit leadership.
Scouting magazine. All registered, paid adult leaders receive Scouting magazine; $2 of the registration
fee is for the subscription.
Boys’ Life. Registered adults get a special rate. For a subscription to a magazine that helps
children grow in the Scouting program, just ll in the Boys’ Life circle on the application and pay
the subscription price.
The annual national registration fee is nonrefundable.
BSA Privacy Policy
The BSA protects the condentiality of the names and personal information of those who are afliated
with the organization. No commercial or unauthorized use is made of the names, addresses, and other
condential information. The BSA and its afnity groups may use registration information to notify
registrants of benet opportunities.
For general questions, contact your local BSA council.
What Is the BSA Program?
The BSA program is outlined in the ofcial publications of the BSA. Activities that are not in these BSA
publications are not a part of the Scouting program. Leaders must not allow youth members or program
participants to engage in any unauthorized or prohibited activities.
Training for New Leaders
The BSA is committed to your success as a volunteer while serving young people. To help you be
successful there are training materials designed for you. Training resources are available through your
local council and at my.Scouting.org.
What Makes a Trained Leader?
You are considered a trained leader when you have completed leader position-specic training for
your position and have current Youth Protection training.
Youth Protection Begins With You™
Child abuse is a serious problem in our society, and unfortunately, it can occur anywhere, even in
Scouting. For that reason, the BSA continues to create barriers to abuse beyond what have previously
existed in Scouting.
The BSA is committed to providing a safe environment for young people. All adult leaders must complete
Youth Protection training as part of the registration process and renew their training as required. It is
highly recommended that parents who participate in Scouting activities complete YPT. To learn more
about the BSAs Youth Protection resources, go to www.scouting.org/training/youth-protection/.
Mandatory Reporting
All persons involved in Scouting must immediately report to local authorities any good-faith suspicion
or belief that any child is or has been physically or sexually abused; physically or emotionally neglected;
exposed to any form of violence or threat; or exposed to any form of sexual exploitation including the
possession, manufacture, or distribution of child pornography, online solicitation, enticement, or showing
of obscene material. No person may abdicate this reporting responsibility to any other person.
Additionally, any known or suspected abuse or behavior that might put a youth at risk must also be
reported to the local Scout executive or the Scouts First Helpline (1-844-SCOUTS1 or 1-844-726-8871)
if your Scout executive or local council cannot be reached.
Youth Protection Policies
Two registered adult leaders 21 years of age or over are required at all Scouting activities, including
meetings. There must be a registered female adult leader over 21 in every unit serving females.
A registered female adult leader over 21 must be present for any activity involving female youth.
One-on-one contact between adult leaders and youth members is prohibited both inside and
outside of Scouting.
These and other key Youth Protection policies are addressed in the training and at www.scouting.org/
training/youth-protection/.
To learn about the BSAs other health and safety policies, please review the online version of the Guide to
Safe Scouting, the Scouter Code of Conduct, and the Sweet Sixteen of BSA Safety, which are available at
www.scouting.org/health-and-safety.
Scout Oath
On my honor I will do my best to do my duty to God and my country and to obey the Scout Law; to help
other people at all times; to keep myself physically strong, mentally awake, and morally straight.
Scout Law
A Scout is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean,
and reverent.
Signature of applicant Date
Email address Work
(Select one)
Home
Yes No
Boys’ Life
subscription
Country Home address City State Zip code
First name (Full legal name) Middle name Last name Sufx
/ /
Ethnic background: Driver’s license No. State Gender
Social Security No. (required) Occupation Employer
Primary phone Alternate phone Ext. Date of birth (mm/dd/yyyy)
- -
Country Business address City State Zip code
- - X
- -
/ /
Position code Scouting position title Are you an Eagle Scout? Date earned (mm/dd/yyyy)
Black/African American
Caucasian/White
Native American
Hispanic/Latino
Alaska Native
Pacic Islander
Asian
Other
Preferred nickname:
524-501
YPT completion certicate attached Background Check Authorization form attached
To be completed by unit
Careful review of the information provided on this application is a significant step in Scouting’s efforts to protect its youth members and deliver a quality program.
Unit
No.
New leader
Former leader
Position change
Participant
Unit
type:
Pack
Troop
Crew
Transfer application
Enter membership number
from unexpired certicate:
Council No.:
Unit No. or
District name:
Ship
OR
District name
Unit
type:
Pack
Troop
Crew
Ship
Multiple application
Registration
fee
Boys’ Life
fee
PAID: Cash Check No. ________ Credit card
M F
Please print one letter in each space.
Signature of chartered organization head or representative Date Signature of Scout executive or designee Date
APPROVALS FOR UNIT ADULTS: I have reviewed this application and the responses to any questions answered “Yes,” and
have made any follow-up inquiries necessary to be satised that the applicant possesses the moral, educational, and
emotional qualities to be an adult leader in the BSA.
APPROVAL FOR COUNCIL AND DISTRICT ADULTS: I have reviewed this application and have made any follow-up inquiries
necessary to be satised that the applicant possesses the moral, educational, and emotional qualities to be an adult leader
in the BSA.
BSA ADULT APPLICATION
I hereby certify that:
1. I have read and afrm that I accept the Declaration of Religious Principle. I agree to comply with the rules and regulations of
the BSA and the local council, including the Scouter Code of Conduct.
INITIALS
REQUIRED
_________
2. I afrm that the information contained in this application is true and accurate to the best of my knowledge and belief. INITIALS
REQUIRED
_________
All questions MUST be answered. Write NONE if applicable.
1. Scouting background.
Position Council Year
____________________________________
____________________________________
____________________________________
2. Experience working with youth in other
organizations. Please provide contact information.
____________________________________
____________________________________
____________________________________
3. Previous residences (for last 10 years).
City State
_______________________ ____________
_______________________ ____________
_______________________ ____________
4. Current memberships (religious, community,
business, labor, or professional organizations).
____________________________________
____________________________________
____________________________________
5. References. Please list those who are familiar with
your character. References may be checked.
Name __________________________________
Telephone (_____) _________________________
Name __________________________________
Telephone (_____) _________________________
Name __________________________________
Telephone (_____) _________________________
6. Additional information. Yes No
(Mark each answer.)
a. Have you ever been removed from
or asked to leave a leadership
position in an organization due to
allegations regarding your personal
conduct or behavior? Explain:
____________________________________
____________________________________
____________________________________
b. Do you use illegal drugs or abuse
alcohol? Explain:
____________________________________
____________________________________
____________________________________
c. Have you ever been arrested for a
criminal offense (other than minor
trafc violations)? Explain:
____________________________________
____________________________________
____________________________________
d. Has your driver’s license ever been
suspended or revoked? Explain:
____________________________________
____________________________________
____________________________________
e. Have you ever been investigated for,
accused of, or charged with abuse or
neglect of a minor child? Explain:
____________________________________
____________________________________
____________________________________
f. Are you aware of any reason
not listed above that may call
into question your suitability to
supervise, guide, care for, and lead
young people?
____________________________________
____________________________________
____________________________________
If applicant has an unexpired membership certicate, registration may be accomplished at no charge by transferring the registration
or multiple registering.
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BACKGROUND CHECK
DISCLOSURE
A consumer report is a background check in which information (which may include, but is not limited to,
criminal background, driving background, character, general reputation, personal characteristics, and mode of
living) about you is gathered and communicated by a consumer reporting agency (“CRA”) to Boy Scouts of
America and/or its subsidiaries, affiliates, other related entities, and/or successors (the “Company”).
Company may obtain a consumer report on you to be used for employment purposes (in your case, this means
for the purpose of evaluating you as a new or existing volunteer).
Tear off the following pages and provide to applicant separately.
CALIFORNIA
STATE LAW DISCLOSURES
(Non-Credit)
Under California law, an “investigative consumer report” is a consumer report in which information on a
consumer’s character, general reputation, personal characteristics, or mode of living is obtained through any
means. Boy Scouts of America and/or its subsidiaries, affiliates, other related entities, and/or successors (the
“Company”) may obtain an investigative consumer report (which may include information described above)
from an investigative consumer reporting agency (“ICRA”) on you in connection with your status as a
volunteer (i.e., for employment purposes under California law). The nature and scope of this investigation
includes your character, general reputation, personal characteristics, or mode of living information, including
criminal history and driving record.
The ICRA preparing the investigative consumer report and conducting the investigation will be First
Advantage, P.O. Box 105292, Atlanta, GA 30348, 800-845-6004. Information regarding First
Advantage’s privacy practices can be found at https://fadv.com/privacy-policy/.
Under California Civil Code section 1786.22, you are entitled to a visual inspection of files maintained on
you by an ICRA, as follows:
(1) In person, if you appear in person and furnish proper identification, during normal business hours and
on reasonable notice. A copy of your file shall also be available to you for a fee not to exceed the
actual costs of duplication services provided;
(2) By certified mail, if you make a written request, with proper identification, for copies to be sent to a
specified addressee. An ICRA complying with requests for certified mailings under California Civil
Code section 1786.22 shall not be liable for disclosures to third parties caused by mishandling of mail
after such mailings leave the ICRA;
(3) A summary of all information contained in your files and required to be provided by California Civil
Code section 1786.10 shall be provided to you by telephone, if you have made a written request, with
proper identification for telephone disclosure, and the toll charges, if any, for the telephone call are
prepaid by you or charged directly to you.
“Proper Identification,” as used above, means information generally deemed sufficient to identify you, which
includes documents such as a valid driver’s license, social security account number, military identification card,
and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional
information concerning your employment and personal or family history in order to verify your identity.
The ICRA will provide trained personnel to explain any information furnished to you pursuant to California
Civil Code section 1786.10 and will provide a written explanation of any coded information contained in files
maintained on you. This written explanation will be provided whenever a file is provided to you for visual
inspection under California Civil Code section 1786.22.
You may be accompanied by one other person of your choosing, who must furnish reasonable identification.
An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file
in such person’s presence.
40832775.1
ADDITIONAL DISCLOSURES & BACKGROUND CHECK AUTHORIZATION
Additional Disclosures
The state disclosures below are included because state law requires them to be provided in
writing. Some of the below rights, notices, or information also may apply to individuals from,
applying to, or volunteering in states not listed below. There may be additional requirements,
options, or provisions applicable to you and you may have additional rights under
applicable law that are not required to be disclosed to you in writing.
Minnesota: You have the right to request a complete and accurate disclosure of the nature and scope
of any consumer report from First Advantage, P.O. Box 105292, Atlanta, GA 30348, 800-845-6004.
New York: Boy Scouts of America and/or its subsidiaries, affiliates, other related entities, and/or
successors (the “Company”) may request or utilize subsequent consumer reports (other than
investigative consumer reports) on you throughout your volunteer relationship with Company. Upon
request, you will be informed whether or not a consumer report was requested, and if such report was
requested, informed of the name and address of the CRA that furnished the report. Your written
request should be made to Company at Boy Scouts of America, Membership Standards Team S201,
1325 West Walnut Hill Lane, P.O. Box 152079, Irving Texas 75015-2079. You may also contact the
Company by email at MembershipStandards@scouting.org
AUTHORIZATION
(Please print)
Name: First ____________________ Middle _______________
Last ________________________ Suffix _________
List any other names used (nickname, maiden/married last names: _________________________________________
Date of Birth: _______________________________
Unit Type and Number: _______________________________
To the extent permitted by applicable law, I hereby consent to and authorize the Boy Scouts of
America and/or its subsidiaries, affiliates, other related entities, and/or successors (the “Company”)
to procure consumer report(s) (as defined by federal law) and/or investigative consumer report(s) (as
defined by applicable California state law), which in my case means criminal background
check(s)/driving record(s), on my background from a consumer reporting agency (“CRA”) or from an
investigative consumer reporting agency (“ICRA”), as described in the Background Check
Disclosure and the California State Law Disclosures (Non-Credit) (each of which I have
received separately from the Company), as well as these Additional Disclosures & Background
Check Authorization. This authorization applies only to criminal checks/driving records and does
not allow the Company to obtain credit checks. I have reviewed and understand the information,
statements, and notices in the Background Check Disclosure and the California State Law
Disclosures (Non-Credit), as well as these Additional Disclosures & Background Check
Authorization. My authorization remains valid throughout my volunteer relationship with the
Company, such that, to the extent permitted by applicable law, I agree Company can procure
additional consumer report(s), which in my case means criminal background check(s)/driving
record(s), during my volunteer relationship without providing additional disclosures or obtaining
additional authorizations. Except as otherwise prohibited by applicable law, I consent to and
authorize the Company to share this information with Company’s local councils and/or chartered
organizations for business reasons (e.g., to place me in certain positions, work sites, etc.). I
understand that, if I am selected for a volunteer position, a consumer report will have been
conducted on me.
For California, Minnesota, or Oklahoma individuals: If you would like to receive from the
CRA, the ICRA, or the Company (as applicable) a copy of the report that Company may procure, please
check this box.
Signature _______________________________________ Date ________________________________________
ADDITIONAL DISCLOSURES & BACKGROUND CHECK AUTHORIZATION
Additional Disclosures
The state disclosures below are included because state law requires them to be provided in
writing. Some of the below rights, notices, or information also may apply to individuals from,
applying to, or volunteering in states not listed below. There may be additional requirements,
options, or provisions applicable to you and you may have additional rights under
applicable law that are not required to be disclosed to you in writing.
Minnesota: You have the right to request a complete and accurate disclosure of the nature and scope
of any consumer report from First Advantage, P.O. Box 105292, Atlanta, GA 30348, 800-845-6004.
New York: Boy Scouts of America and/or its subsidiaries, affiliates, other related entities, and/or
successors (the “Company”) may request or utilize subsequent consumer reports (other than
investigative consumer reports) on you throughout your volunteer relationship with Company. Upon
request, you will be informed whether or not a consumer report was requested, and if such report was
requested, informed of the name and address of the CRA that furnished the report. Your written
request should be made to Company at Boy Scouts of America, Membership Standards Team S201,
1325 West Walnut Hill Lane, P.O. Box 152079, Irving Texas 75015-2079. You may also contact the
Company by email at MembershipStandards@scouting.org
AUTHORIZATION
(Please print)
Name: First ____________________ Middle _______________
Last ________________________ Suffix _________
List any other names used (nickname, maiden/married last names: _________________________________________
Date of Birth: _______________________________
Unit Type and Number: _______________________________
To the extent permitted by applicable law, I hereby consent to and authorize the Boy Scouts of
America and/or its subsidiaries, affiliates, other related entities, and/or successors (the “Company”)
to procure consumer report(s) (as defined by federal law) and/or investigative consumer report(s) (as
defined by applicable California state law), which in my case means criminal background
check(s)/driving record(s), on my background from a consumer reporting agency (“CRA”) or from an
investigative consumer reporting agency (“ICRA”), as described in the Background Check
Disclosure and the California State Law Disclosures (Non-Credit) (each of which I have
received separately from the Company), as well as these Additional Disclosures & Background
Check Authorization. This authorization applies only to criminal checks/driving records and does
not allow the Company to obtain credit checks. I have reviewed and understand the information,
statements, and notices in the Background Check Disclosure and the California State Law
Disclosures (Non-Credit), as well as these Additional Disclosures & Background Check
Authorization. My authorization remains valid throughout my volunteer relationship with the
Company, such that, to the extent permitted by applicable law, I agree Company can procure
additional consumer report(s), which in my case means criminal background check(s)/driving
record(s), during my volunteer relationship without providing additional disclosures or obtaining
additional authorizations. Except as otherwise prohibited by applicable law, I consent to and
authorize the Company to share this information with Company’s local councils and/or chartered
organizations for business reasons (e.g., to place me in certain positions, work sites, etc.). I
understand that, if I am selected for a volunteer position, a consumer report will have been
conducted on me.
For California, Minnesota, or Oklahoma individuals: If you would like to receive from the
CRA, the ICRA, or the Company (as applicable) a copy of the report that Company may procure, please
check this box.
Signature _______________________________________ Date ________________________________________
.
:
02/2020
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