Fillable Merit Badge Counselor Applications (Chester County Council, Boy Scouts of America)

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Merit Badge Counselor Applications (Chester County Council, Boy Scouts of America)

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Merit Badge Counselor Applications
This form is available electronically at www.cccbsa.org, Resources, Forms, For Parents and Leaders, Merit Badge Counselor Application.
You can download and save this form, then open it with Adobe Reader (free download from http://get.adobe.com/reader/), fill out
the form electronically, sign it digitally, and email it to registrar@cccbsa.org with all required documents.
There are five steps to register to be a merit badge counselor. These steps are the same for council-wide, troop-only, and camp/
special event merit badge counselors. No person should meet with Scouts as a merit badge counselor or sign a merit badge blue
card until they have completed this process and received notification that they have been approved.
Before applying to be a merit counselor for any merit badge, be sure you are familiar with all the requirements and are well
qualified to teach all the material covered by all the requirements. You can check out the requirements, as well as various
teaching aids, at usscouts.org/meritbadges.asp. You should be an expert in the field, not just a facilitator.
1) Fill out the MERIT BADGE COUNSELOR INFORMATION form. This form is after these instructions. It defines which
merit badges you are willing to be a merit badge counselor for, why you are qualified as an expert in these subject areas, and
whether you want to be listed on the merit badge counselor lists sent to just one troop or the lists sent to multiple local troops. This
first form can also be used later to add additional merit badges or units. Except in unusual circumstances, you will not be approved
as a merit badge counselor for more than 15 merit badges; including not more than 5 Eagle-required merit badges.
NOTE: Some merit badge counselors are required to have specific certifications or qualifications. See the list on the third
page for these merit badges and the qualifications. Send your certifications with this application.
Once you are registered as a merit badge counselor, your name and contact information will be included on merit badge counselor
lists for multiple units near you, or just a specific unit. These lists are published three times per year and the information is
available to leaders through the ScoutBook app.
Each year you will be sent an email asking you to confirm that you are willing to continue as a merit badge counselor. You must
reply in the affirmative to this message, and you must have current Youth Protection Training and Pennsylvania Act 15 (formerly
Act 153) certifications, to stay on the list.
For signatures, click in the box, use an existing Digital ID or Configure Digital ID, Create a new Digital ID, Save to Windows
Certificate Store, complete and save.
2) Fill out the ADULT APPLICATION. This form must be submitted for the merit badge counselor position even if you are
already registered as a Scoutmaster, assistant Scoutmaster, member of committee, or any other position. This is a requirement of
BSA national and is not a local requirement. This form is included below. It is two pages and both the ADULT APPLICATION
and Background Check Authorization must be submitted to the council office. Note that the Social Security Number is required
unless you are already registered in another position and your social security number is on file. If you are already registered in
another position, provide that information (Chester County Council is #539).
As a merit badge counselor, you will officially be a council Scouter (on the council charter not the unit charter), so no unit
signatures are required. There is no fee to register as a merit badge counselor. Leave the APPROVAL FOR COUNCIL AND
DISTRICT SCOUTERS signature blank.
3) Complete Youth Protection Training. Go to http://My.Scouting.org . The best browsers to use are the latest versions of Google
Chrome or Mozilla Firefox. The latest version of Safari or Internet Explorer version 11 will also work. If you see the Scout logo
with a gray bar under it and it goes no further, your internet browser will not work. If you have no idea what internet browser you
have, ask for assistance from your technology friends or family! If you have never taken a training at My.Scouting.org you will
need to click Create Account and create a new account. If you have taken a training, your username and password will be the same
as before. If you have forgotten your username or password, you can click on the links for assistance. If you still have difficulties
logging into your account contact the Member Care desk at 972-580-2489 or email myscouting@scouting.org.
Take YPT!
You’re now ready to take Youth Protection Training!
From the Home page, click the YOUTH PROTECTION BEGINS WITH YOU icon. Click on How to Guide for Taking Youth
Protection Training. Read, and it is probably a good idea to print, these instructions. There are four parts to the course, three
training videos and the certification test. You must complete all four parts. After completing all four parts of the training, you will
receive an email with your certificate attached. This typically takes about 15 minutes to arrive, although the web site says it may be
up to 48 hours. If you have any questions, let us help! Email us at ypt@cccbsa.org.
4) Meet the requirements of Pennsylvania Act 15 (formerly Act 153). This applies to all merit badge counselors unless these
certifications are already on file at the council office. Additional information is available at http://www.cccbsa.org/resources/pa-
background-checks/clearances.
If you live in (and do your merit badge counseling in) Maryland (or any state beside Pennsylvania) all you need to do is fill out and
submit the council’s Maryland Scouter Waiver of Pa Mandated Background Checks available at https://www.cccbsa.org/wp-
content/uploads/B-Waiver-Maryland-Volunteers.pdf. Leave the BSA Member ID Number blank if you are not registered. Leave
Unit Type, Unit #, and the Unit Verification section blank if you have no association with a Scout unit. This waiver covers all three
requirements of PA Act 15 (formerly Act 153).
If you live in Pennsylvania you must complete 3 parts of the PA Mandated Background Check Certifications:
A) You need to get and submit a Report of criminal history from the Pennsylvania State Police (PSP). This is free for volunteers
and you can get this online at https://epatch.state.pa.us/TandCVolunteerAction.do. Click on New Record Check (Volunteers
only). The Organization Name is Boy Scouts of America and the Telephone Number is 610-696-2900. You first enter
information on who is requesting the information (you) and then on the person whose record is to be checked (also you). Once
you Enter This Request and Submit, be sure to write down your Control #. The results usually come back in seconds. Click on
the Control #, then Certification Form. Print and save the “Response for Criminal Record Check” (with the keystone
background). This free report is valid for 60 months and you cannot get another one free for 57 months, so keep a copy in case
you need it for another organization. If you have already done this for another organization, submit that report. You do not
need to repeat the process. A copy of this report needs to be submitted with your merit badge counselor application if it is not
already on file with the Council.
B) You need to get and submit a Child Abuse History Clearance from the Department of Human Services. This is free for
volunteers (only once every 57 months and when submitted electronically) and you get it online at
https://www.compass.state.pa.us/CWIS. You will need to CREATE INDIVIDUAL ACCOUNT. A temporary password will be
emailed to you. Change it to something you can remember. Be sure to record your User ID and Password once you set your
Permanent Password. LOGIN, ACCESS MY CLEARANCES, CREATE CLEARANCE APPLICATION, Volunteer Having
Contact with Children, Volunteer Category=Other, Agency Name=Chester County Council, BSA. Enter the information
requested including Name, Date of Birth, Gender, Social Security Number, previous/nick/maiden names, Phone number(s),
Current and previous addresses since 1975, household members you have lived with since 1975 (parents/siblings/children, not
everyone in your military unit or college dorm) and electronically sign the application. As a volunteer you do not need an
authorization code and do not have one. Submit the application and you will receive an email confirmation. If there are no
problems with your clearance, you should receive another email in 45 seconds to several weeks saying the results are available.
Click the link to the CWIS website, ACCESS CLEARANCES, login, click on “to view the result click here”. Print and save
the PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION. A copy of this report needs to be submitted with your
merit badge counselor application if it is not already on file with the Council.
C) If you have been a Pennsylvania resident for the entirety of the last 10 years, download the waiver from http://www.cccbsa.org/
filestore/membership/Act153/A-Volunteer Disclosure Statement in place of FBI Clearance.pdf. Print and sign the waiver. Any
adult can witness the document. If you do not know your BSA Member ID Number, leave that blank. If you are not associated
with a unit, leave the unit information blank.
If you have not lived in Pennsylvania for all the last 10 years, you will need to obtain and submit the fingerprint-based FBI
criminal history clearance submitted through the Department of Human Services at a cost of about $21.35. Go to
www.identogo.com, click Get Fingerprinted, select your state, click Go, click Digital Fingerprinting, enter Service Code
1KG6ZJ, click GO, click Schedule or Manage Appointment, fill in the requested information on 6 pages and click Next for
each, enter zip code and click Search, choose location and click Next, choose date/time and click Submit. Go to the location at
the appointed time for your fingerprinting. Results will be sent to you in about two weeks. A copy of this report needs to be
submitted with your merit badge counselor application if it is not already on file with the Council.
5) Submit all the above forms to the council registrar at registrar@cccbsa.org. This includes the MERIT BADGE
COUNSELOR INFORMATION form, both pages of the ADULT APPLICATION/Background Check Authorization, a copy of
your Youth Protection Training certificate, the three PA Act 15 certifications unless they are already on file at the Council, and
any required qualification certifications. See the next page for certifications for specific merit badges that must be submitted with
your application. If you are just adding additional merit badges and everything else is current, all that is needed is the MERIT
BADGE COUNSELOR INFORMATION form and any required qualification certifications. The best way to submit these forms is
to email them to registrar@cccbsa.org. DO NOT GIVE THE PAPERWORK TO YOUR UNIT.
You should receive a confirmation within about two to four weeks that your application has been processed and you can start to
serve as a merit badge counselor.
THANK YOU for your commitment to Scouting!
Available Training: Many on-line training courses are available at http://My.Scouting.org, the same site where you took the YPT
training. This includes various optional trainings for Merit Badge Counselors if you want to know more. After signing on, click on
Menu, My Training, Training Center, Scouts BSA. Under Scouts BSA – Merit Badge Training click + Add Plan to put these
courses in your training plan. Then click on Scouts BSA – Merit Badge Counselor Training and Scouts BSA – Merit Badge
Counselors – Before the First Meeting. From this screen you can click Launch Course for each module of the training. You can
repeat the process for Scouts BSA – Merit Badge Counselors – Position Trained. These are not required trainings.
A useful reference about the job of merit badge counseling is “A Guide for Merit Badge Counseling” available from
https://filestore.scouting.org/filestore/pdf/512-065.pdf.
MERIT BADGES WITH SPECIFIC REQUIREMENTS FOR MERIT BADGE
COUNSELOR QUALIFICATIONS AND CERTIFICATIONS
The BSA Guide to Safe Scouting, Guide to Advancement, and various merit badge pamphlets define safety requirements for merit badge
counselors and merit badge activities. To meet these requirements, the Chester County Council Advancement Committee has
implemented policies regarding applications for certain merit badge counselors.
The list below is just the merit badges for which you must submit copies of your certifications with your application to be a merit badge
counselor. All certificates must be current. There are many other merit badges that describe safety requirements for supervision of
conditions for certain activities in the merit badge. You should be familiar with these requirements that are detailed in the Notes to
Counselor on the inside front cover of many merit badge pamphlets. Before you apply to be a counselor for a merit badge, be sure you
have studied the requirements for the badge and the related safety requirements, and be sure you will be able to teach all of the material in
the badge within the BSA safety requirements.
Archery Merit Badge: Archery merit badge counselors must be a BSA National Camping School trained shooting sports director or
USA Archery or National Field Archery Association instructor, or be trained by one of these three; or have at least Level 1 training in the
operation of an archery range from USA Archery, NFAA, or an equivalent. Send a copy of your certification with this application or send
details of your training and certification in archery.
Climbing: Send a copy of your BSA Climb on Safely certificate (available at My.Scouting.org). BSA recommends BSA climbing Level
2 instructor training. Send details of your climbing instructor training.
Canoeing Merit Badge: Canoeing merit badge counselors must have either BSA Aquatics Instructor or Canoeing Instructor certification
from the American Canoe Association, American Red Cross, or equivalent; or be trained by an instructor so qualified. Send a copy of
your certification with this application or send details of your formal training in teaching canoeing. Also send a copy of your BSA Safety
Afloat certification (available from My.Scouting.org).
Kayaking: Kayaking merit badge counselors must have formal training in kayaking and paddle craft instruction, evidenced by either
BSA Aquatics Instructor or Paddle Craft Safety Instructor certification or kayaking instructor certification from the American Canoe
Association, British Canoe Union, American Red Cross, or equivalent; or be trained by an instructor so qualified. Send a copy of your
certification with this application or send details of your formal training in teaching kayaking. Also send a copy of your BSA Safety
Afloat certification (available from My.Scouting.org).
Lifesaving Merit Badge: Lifesaving merit badge counselors must be at least 21 years old with certification in Red Cross First
Aid/CPR/AED or equivalent, and also as BSA Lifeguard or Aquatics Instructor or equivalent. We will accept American Red Cross
Lifeguarding Instructor or YMCA Lifeguard Instructor as equivalent. Send a copy of your certifications with this application. Send a copy
of your BSA Safe Swim Defense certification (available from My.Scouting.org).
Motor Boating: Motor Boating counselors must be at least 21 years old with appropriate credentials including current or previous
certification by an organization (such as the National Safe Boa
ting Council, the United States Power Squadrons, the U.S. Coast Guard
Auxiliary, or the US Powerboating component of US Sailing) that meets the voluntary National On-Water Standards for Powerboating or
the NASBLA national boating education standards for powerboating; or trained by an instructor so qualified. Send details of your training
and certifications or equivalent training with this application. Also send a copy of your BSA Safety Afloat certification (available from
My.Scouting.org).
Rifle Shooting Merit Badge: Rifle Shooting merit badge counselors must have a current BSA National Camping School (NCS) shooting
sports director certification or a current National Rifle Association (NRA) Rifle Shooting Instructor or Coach certification. If you will be
offering the muzzle loading option in the merit badge, you must be an NCS shooting sports director or NRA or National Muzzleloader
Rifle Association (NMLRA) certified muzzleloader firearms instructor. All shooting must be supervised by an NRA certified Range
Safety Officer (RSO). The Instructor and the RSO cannot be the same person (Two certified people are required when shooting). Note
that commercial shooting ranges may provide RSOs. Send a copy of your certifications with this application.
Rowing Merit Badge: Rowing merit badge counselors must have either BSA Aquatics Instructor certification or equivalent or be trained
by an instructor so qualified. Send a copy of your certification with this application or send a description of your equivalent training. Also
send a copy of your BSA Safety Afloat certification (available from My.Scouting.org).
Shotgun Shooting Merit Badge: Shotgun Shooting merit badge counselors must have a current BSA National Camping School (NCS)
shooting sports director certification or a current National Rifle Association (NRA) Shotgun Shooting Instructor or Coach certification. If
you will be offering the muzzle loading option in the merit badge, you must be an NCS shooting sports director or NRA or National
Muzzleloader Rifle Association (NMLRA) certified muzzleloading shotgun instructor. All shooting must be supervised by an NRA
certified Range Safety Officer (RSO). The Instructor and the RSO cannot be the same person (Two certified people are required when
shooting). Note that commercial shooting ranges may provide RSOs. Send a copy of your certifications with this application.
Small Boat Sailing: Small Boat Sailing merit badge counselors must be at least 21 years old with appropriate credentials such as
instructor certification with a recognized sailing agency or school, US Sailing, or the American Sailing Association for sailing experience
with different hull types including the rig being used for instruction. Send details of your instructor trainings and certifications with this
application. Also send a copy of your BSA Safety Afloat certification (available from My.Scouting.org).
Swimming: Send a copy of your BSA Safe Swim Defense and BSA Safety Afloat certifications (available from My.Scouting.org).
Water Sports: Send a copy of your BSA Safe Swim Defense and BSA Safety Afloat certifications (available from My.Scouting.org).
Whitewater Merit Badge: Whitewater merit badge counselors must be certified as whitewater canoeing or kayaking instructors by the
American Canoe Association or have equivalent certification, training, or expertise. Send a copy of your certification with this application
or send a description of your equivalent training. Also send a copy of your BSA Safety Afloat certification (available from
My.Scouting.org).
Chester County Council, BSA
(Please fill out and submit electronically) MERIT BADGE COUNSELOR INFORMATION
Name: ____________________________________________ Primary phone ______________________ Home Cell Work
Address: __________________________________________ Other phone ________________________ Home Cell Work
City/State/Zip______________________________________ Can you work with Scouts in Spanish? Yes No
Date of Birth:_______________ E-mail ________________________________________________
I am associated with (adult registration or son in): Troop Number __________ I am not associated with a troop.
As a merit badge counselor, I agree to:
follow the most current requirements of the B.S.A. Merit Badge in this subject, making no deletions or additions, ensuring that the advancement standards are
fair and uniform for all scouts. Note: Current requirements can be found in the latest “Scouts BSA Requirements” book (published annually) or at
usscouts.org/meritbadges.asp or http://www.scouting.org/meritbadges.aspx.
have a Scout accompanied by their buddy during all instructional sessions. Note: This is BSA policy for “Youth Protection”. Youth Protection Training is
available online at http://My.Scouting.org. A copy of your certificate should accompany this application.
renew my YPT and registration annually if I plan to continue as a merit badge counselor. Note: A renewal email will be sent to you each year. Please reply
promptly indicating whether or not you wish to renew.
List Merit Badge(s) here
Please describe your qualifications for this merit badge. Be specific as to whether this is your job or hobby
and the kind and amount of training you have in this subject. What is the basis for your passion for this
subject? What would you list as qualifications on a job application for a job in this field?
1.
I have read the requirements and am
qualified to teach all the requirements.
Yes No
2.
I have read the requirements and am
qualified to teach all the requirements.
Yes No
3.
I have read the requirements and am
qualified to teach all the requirements.
Yes No
4.
I have read the requirements and am
qualified to teach all the requirements.
Yes No
5.
I have read the requirements and am
qualified to teach all the requirements.
Yes No
List additional merit badges and qualification information on additional sheets. (Max. 15 total including 5 Eagle required)
CHECK ONE
: (Note-this only determines what list you are published on. Once approved you may work with Scouts from any unit)
I wish to be listed on merit badge counselor list just for unit number _________________.
I wish to be listed on merit badge counselor lists for all local troops.
I wish to be registered as a merit badge counselor for summer camp staff.
I wish to be registered only for a specific event or merit badge program at __________________________________________.
The Scout should provide you with a blue card with his Scoutmaster’s signature before starting the merit badge.
CHECK ONE:
I have attached a new B.S.A. Adult application listing position code 42 - Merit Badge Counselor (see next two pages).
I am already registered as a Merit Badge Counselor (position code 42) and listed on the current council-published list as a
registered Merit Badge Counselor, in addition to any other positions for which I am already registered.
REQUIRED:
Youth Protection Training date ________________ (ATTACH COPY OF THE CURRENT CERTIFICATE).
All 3 PA Act 15 Certifications (or MD waiver) are Attached OR Already on file at the Council office
Signature and date (click to provide digital signature): ____________________________________________________________
Once all the paperwork is submitted to the council office, you should receive confirmation within about 2-4 weeks that you have
been approved. You should not meet with any Scouts about merit badges until you have received this confirmation. If there is any
problem with your application, you will be contacted. Contact advancement@cccbsa.org if you have questions.
___________________________________________FOR COUNCIL ADVANCEMENT COMMITTEE USE ONLY_______________________________________________
02/06/2020 edition AA ABD YPT PSP DHS FBI CCC AC APPROVAL ______________________________________ DATE _____________
click to sign
signature
click to edit
Please print one letter in each space BSA ADULT APPLICATION
First Name (Full legal name) Middle Name Last Name Suffix
Country Home Address City State Zip Code
Primary Phone Home Cell Work Alternate Phone Home Cell Work Ext. Date of birth (mm/dd/yyyy
Ethnic background: Driver’s license No. State Gender
M F
Black/African American Native American Alaska Native Asian
Caucasian/White Hispanic/Latino Pacific Islander Other
Social Security Number (required) Occupation Employer
Country Business Address City State Zip Code
Position Code Position (Description) Are you an Eagle Scout? Date earned (mm/dd/yyyy)
E-mail address Work
(Select one)
Home
I hereby certify that:
1. I have read and affirm that I accept the Declaration of Religious Principle. I agree to comply with the rules and regulations of INITIALS
the BSA and the local council, including the Scouter Code of Conduct. REQUIRED
_________ Signature and date (click to provide digital signature)
2. I affirm that the information contained in this application is true and accurate to the best of my knowledge and belief. INITIALS YPT completion certificate attached Background Check Authorization form attached
REQUIRED
_________
If you are already registered with the Boy Scouts of America in any other capacity, please provide that information:
Council No. or Name: Unit Type:
Pack Troop Crew Ship
Unit No. Or District Name:
To be completed by the Council office
524-501
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 or 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
a criminal offense (other than minor
traffic 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?
________________________________________
Preferred Nickname if other than First Name:
U S A
-
-
-
-
X
/
/
U S A
-
-
4 2
Merit Badge Counselor
Yes
No
/ /
APPROVAL FOR COUNCIL AND DISTRICT ADULTS: I have reviewed this application and
have made any follow-up inquiries necessary to be satisfied that the applicant possesses the
moral, educational, and emotional qualities of an adult leader in the BSA.
Signature of Scout Executive or designee Date
Chester County Council 539
click to sign
signature
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DISCLOSURES & BACKGROUND CHECK AUTHORIZATION
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, successors, and/or assigns (the “Company”).
Company may obtain a consumer report on you to be used for employment purposes as defined by applicable law (in your case this
means for the purpose of evaluating you as a new or existing volunteer).
Additional Disclosures
If you are a resident of Minnesota, New York, California, Minnesota, or Oklahoma; see additional disclosures available in
https://filestore.scouting.org/filestore/pdf/524-501.pdf or the printed Adult Application available from the council office.
Background Check Authorization
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), which in my case means criminal
background check(s)/driving record(s), on my background from a consumer reporting agency (“CRA”), as described in the
Background Check Disclosure (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, 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.
_______________________________________________
Signature and date (click to provide digital signature)
Please fill out electronically.
Name: First ___________________________ Middle ______________ Last _______________________________ Suffix ____
List any other names used (nickname, maiden/married last names: ___________________________________________________
Date of Birth: _____________ Unit Type and Number: Merit Badge Counselor
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Merit Badge Counselor Applications (Chester County Council, Boy Scouts of America)

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