REQUIREMENT 4. While a Life Scout, serve actively in your unit for a period of six
months in one or more of the following positions of responsibility. List only those
positions served after Life board of review date.
Scout troop. Patrol leader, assistant senior patrol leader, senior patrol leader, troop
guide, Order of the Arrow troop representative, den chief, scribe, librarian, historian,
quartermaster, junior assistant Scoutmaster, chaplain aide, instructor, webmaster,
outdoor ethics guide
Venturing crew. President, vice president, secretary, historian, den chief, treasurer,
guide, quartermaster, chaplain aide, outdoor ethics guide
Sea Scout ship. Boatswain, boatswain’s mate, purser, yeoman, storekeeper, crew
leader, media specialist, specialist, den chief, chaplain aide
Lone Scout: Leadership responsibility in your school, religious organization, or club,
or elsewhere in your community
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.
Position
_________________________________________________________________
Position _________________________________________________________________
Month Day YearMonth Day Year
Month Day YearMonth Day Year
Month Day Year
REQUIREMENT 6. While a Life Scout, participate in a unit leader conference.
Month Day Year
Date conference was held
Date project finished
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.
Scoutmaster, Advisor, or Skipper
Month Day Year
Date
Month Day Year
Date
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.
Month Day Year
Date
______________________________________________
Signature of Eagle Scout board of review chair
______________________________________________
Signature of council/district board representative (if applicable)
Signed _________________________________________ Position_________________________________
Month Day Year
Date
Month Day Year
Date of Life Scout
board of review
Date
FROM
TO
FROM
TO
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__________________
* 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__________________
Signature of unit committee chair _
___________________________________________ Telephone__________________
Month Day Year
Date
I certify that all procedures, as outlined in the Guide to Advancement, have been followed. I approve this application.
Scout executive
___________________________________________________________________________________
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.
512-728
January 2020 Printing
Project name: _____________________________________________________________
Grand total of hours: __________ (from Eagle Scout Service Project Workbook—for statistical purposes only)
