BSA New Adult Application
BSA New Adult Application
BY SUBMITTING THIS APPLICATION YOU ARE AUTHORIZING A CRIMINAL BACKGROUND CHECK OF YOURSELF.
THIS CHECK WILL BE MADE FROM PUBLIC RECORD SOURCES. YOU WILL HAVE AN OPPORTUNITY TO
REVIEW AND CHALLENGE ANY ADVERSE INFORMATION DISCLOSED BY THE CHECK.
IF YOU WOULD LIKE A COPY OF YOUR CRIMINAL BACKGROUND REPORT,
PLEASE CONTACT YOUR LOCAL COUNCIL OFFICE.
Signature of applicant Date (ACCEPTED) Signature of Scout executive or designee Date Signature of Scout executive or designee Date
Registration fee
$ . Boys’ Life fee $ . LOCAL COUNCIL COPY Retain on file for three years. 28-501E
ADULT APPLICATION
UNIT SCOUTERS (Fill in the circle.) Council/district position 1. Scouting background.
Position Council Year
The information obtained in this form is for the Pack Troop Team Crew Ship Unit ___________________________________
internal use of the BSA only. No. Or ___________________________________
District name ___________________________________
2. Experience working with youth in other
Expire date / / Term MONTHS New leader Former leader organizations.
___________________________________
___________________________________
If applicant has an unexpired membership certificate; registration may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council. 3. Previous residences (for last five years).
City State
TRANSFER FROM: COUNCIL NO. TYPE OF UNIT Unit NO. ___________________________________
___________________________________
Please print one letter in each space—press hard; you are making three copies. ___________________________________
___________________________________
First name (No initials or nicknames) Middle name Last name Suffix
4. Current memberships (religious, community,
business, labor, or professional organizations).
___________________________________
Have you completed: Youth Protection training Fast Start training ___________________________________
5. References. Please list those who are familiar
Country Mailing address City State Zip code with your character as it relates to working
with youth. References will be checked when
US necessary.
Name_________________________________
Home phone Business phone Ext. Cell phone Telephone (_____)________________________
Name_________________________________
- - - - X - - Telephone (_____)________________________
Name_________________________________
Date of birth (mm/dd/yyyy) Ethnic background: Driver’s license No. State
Telephone (_____)________________________
African American American Indian Alaska Native Asian 6. Additional information. Yes or No
/ /
Caucasian/White Hispanic/Latino Pacific Islander Other (Mark each answer.)
Gender Social Security number (required) Occupation Employer a. Do you use illegal drugs?
M F b. Have you ever been convicted of
- - a criminal offense? (If yes,
explain below.)
Country Business address City State Zip code c. Have you ever been charged with
child neglect or abuse?
US d. Has your driver’s license ever
Position Code Position (Description) Are you an Eagle Scout? Date earned (mm/dd/yyyy) been suspended or revoked?
(If yes, explain below.)
Yes No / / e. Other than the above, is there any
fact or circumstance involving you
E-mail address Business or your background that would call
(Select one) Home
Boys’ Life
subscription
into question your being entrusted
with the supervision, guidance,
and care of young people? (If yes,
I understand that: APPROVALS FOR UNIT SCOUTERS explain below.)
a. The information that I have provided may be verified, if necessary, by contacting persons We are unaware of anything contrary to the information stated in this application. This application has been reviewed
or organizations named in this application, or by contacting any person or organization according to BSA procedures and this applicant meets the leadership qualifications of the Boy Scouts of America: ___________________________________
that may have information concerning me, or by conducting a criminal background check. ___________________________________
I hereby release and agree to hold harmless from liability any person or organization ___________________________________
that provides information. I also agree to hold harmless the chartered organization, local
council, Boy Scouts of America, and the officers, employees, and volunteers thereof. Signature of unit committee chairman Date
b. In signing this application, I have read the attached information and apply for APPROVAL FOR COUNCIL AND DISTRICT SCOUTERS
registration with the Boy Scouts of America. I agree to comply with the Charter and We are unaware of anything contrary to the information
Bylaws, and the Rules and Regulations of the Boy Scouts of America and the local council. stated in this application. This application has been reviewed
I affirm that the information I have given on this form is true and correct. I will follow the according to BSA procedures and this applicant meets the
Youth Protection guidelines. Signature of chartered organization head or representative Date leadership qualifications of the Boy Scouts of America:
Signature of applicant Date (ACCEPTED) Signature of Scout executive or designee Date Signature of Scout executive or designee Date
Registration fee
$ . Boys’ Life fee $ . CHARTERED ORGANIZATION COPY Retain on file for three years. 28-501E
ADULT APPLICATION
UNIT SCOUTERS (Fill in the circle.) Council/district position 1. Scouting background.
Position Council Year
The information obtained in this form is for the Pack Troop Team Crew Ship Unit ___________________________________
internal use of the BSA only. No. Or ___________________________________
District name ___________________________________
2. Experience working with youth in other
Expire date / / Term MONTHS New leader Former leader organizations.
___________________________________
___________________________________
If applicant has an unexpired membership certificate; registration may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council. 3. Previous residences (for last five years).
City State
TRANSFER FROM: COUNCIL NO. TYPE OF UNIT Unit NO. ___________________________________
___________________________________
Please print one letter in each space—press hard; you are making three copies. ___________________________________
___________________________________
First name (No initials or nicknames) Middle name Last name Suffix
4. Current memberships (religious, community,
business, labor, or professional organizations).
___________________________________
Have you completed: Youth Protection training Fast Start training ___________________________________
5. References. Please list those who are familiar
Country Mailing address City State Zip code with your character as it relates to working
with youth. References will be checked when
US necessary.
Name_________________________________
Home phone Business phone Ext. Cell phone Telephone (_____)________________________
Name_________________________________
- - - - X - - Telephone (_____)________________________
Name_________________________________
Date of birth (mm/dd/yyyy) Ethnic background: Driver’s license No. State
Telephone (_____)________________________
African American American Indian Alaska Native Asian 6. Additional information. Yes or No
/ /
Caucasian/White Hispanic/Latino Pacific Islander Other (Mark each answer.)
Gender Social Security number (required) Occupation Employer a. Do you use illegal drugs?
M F b. Have you ever been convicted of
- - a criminal offense? (If yes,
explain below.)
Country Business address City State Zip code c. Have you ever been charged with
child neglect or abuse?
US d. Has your driver’s license ever
Position Code Position (Description) Are you an Eagle Scout? Date earned (mm/dd/yyyy) been suspended or revoked?
(If yes, explain below.)
Yes No / / e. Other than the above, is there any
fact or circumstance involving you
E-mail address Business or your background that would call
(Select one) Home
Boys’ Life
subscription
into question your being entrusted
with the supervision, guidance,
and care of young people? (If yes,
I understand that: APPROVALS FOR UNIT SCOUTERS explain below.)
a. The information that I have provided may be verified, if necessary, by contacting persons We are unaware of anything contrary to the information stated in this application. This application has been reviewed
or organizations named in this application, or by contacting any person or organization according to BSA procedures and this applicant meets the leadership qualifications of the Boy Scouts of America: ___________________________________
that may have information concerning me, or by conducting a criminal background check. ___________________________________
I hereby release and agree to hold harmless from liability any person or organization ___________________________________
that provides information. I also agree to hold harmless the chartered organization, local
council, Boy Scouts of America, and the officers, employees, and volunteers thereof. Signature of unit committee chairman Date
b. In signing this application, I have read the attached information and apply for APPROVAL FOR COUNCIL AND DISTRICT SCOUTERS
registration with the Boy Scouts of America. I agree to comply with the Charter and We are unaware of anything contrary to the information
Bylaws, and the Rules and Regulations of the Boy Scouts of America and the local council. stated in this application. This application has been reviewed
I affirm that the information I have given on this form is true and correct. I will follow the according to BSA procedures and this applicant meets the
Youth Protection guidelines. Signature of chartered organization head or representative Date leadership qualifications of the Boy Scouts of America:
Signature of applicant Date (ACCEPTED) Signature of Scout executive or designee Date Signature of Scout executive or designee Date
Registration fee
$ . Boys’ Life fee $ . UNIT COPY Retain on file for three years. 28-501E
ADULT APPLICATION
UNIT SCOUTERS (Fill in the circle.) Council/district position 1. Scouting background.
Position Council Year
The information obtained in this form is for the Pack Troop Team Crew Ship Unit ___________________________________
internal use of the BSA only. No. Or ___________________________________
District name ___________________________________
2. Experience working with youth in other
Expire date / / Term MONTHS New leader Former leader organizations.
___________________________________
___________________________________
If applicant has an unexpired membership certificate; registration may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council. 3. Previous residences (for last five years).
City State
TRANSFER FROM: COUNCIL NO. TYPE OF UNIT Unit NO. ___________________________________
___________________________________
Please print one letter in each space—press hard; you are making three copies. ___________________________________
___________________________________
First name (No initials or nicknames) Middle name Last name Suffix
4. Current memberships (religious, community,
business, labor, or professional organizations).
___________________________________
Have you completed: Youth Protection training Fast Start training ___________________________________
5. References. Please list those who are familiar
Country Mailing address City State Zip code with your character as it relates to working
with youth. References will be checked when
US necessary.
Name_________________________________
Home phone Business phone Ext. Cell phone Telephone (_____)________________________
Name_________________________________
- - - - X - - Telephone (_____)________________________
Name_________________________________
Date of birth (mm/dd/yyyy) Ethnic background: Driver’s license No. State
Telephone (_____)________________________
African American American Indian Alaska Native Asian 6. Additional information. Yes or No
/ /
Caucasian/White Hispanic/Latino Pacific Islander Other (Mark each answer.)
Gender Social Security number (required) Occupation Employer a. Do you use illegal drugs?
M F b. Have you ever been convicted of
- - a criminal offense? (If yes,
explain below.)
Country Business address City State Zip code c. Have you ever been charged with
child neglect or abuse?
US d. Has your driver’s license ever
Position Code Position (Description) Are you an Eagle Scout? Date earned (mm/dd/yyyy) been suspended or revoked?
(If yes, explain below.)
Yes No / / e. Other than the above, is there any
fact or circumstance involving you
E-mail address Business or your background that would call
(Select one) Home
Boys’ Life
subscription
into question your being entrusted
with the supervision, guidance,
and care of young people? (If yes,
I understand that: APPROVALS FOR UNIT SCOUTERS explain below.)
a. The information that I have provided may be verified, if necessary, by contacting persons We are unaware of anything contrary to the information stated in this application. This application has been reviewed
or organizations named in this application, or by contacting any person or organization according to BSA procedures and this applicant meets the leadership qualifications of the Boy Scouts of America: ___________________________________
that may have information concerning me, or by conducting a criminal background check. ___________________________________
I hereby release and agree to hold harmless from liability any person or organization ___________________________________
that provides information. I also agree to hold harmless the chartered organization, local
council, Boy Scouts of America, and the officers, employees, and volunteers thereof. Signature of unit committee chairman Date
b. In signing this application, I have read the attached information and apply for APPROVAL FOR COUNCIL AND DISTRICT SCOUTERS
registration with the Boy Scouts of America. I agree to comply with the Charter and We are unaware of anything contrary to the information
Bylaws, and the Rules and Regulations of the Boy Scouts of America and the local council. stated in this application. This application has been reviewed
I affirm that the information I have given on this form is true and correct. I will follow the according to BSA procedures and this applicant meets the
Youth Protection guidelines. Signature of chartered organization head or representative Date leadership qualifications of the Boy Scouts of America:
Signature of applicant Date (ACCEPTED) Signature of Scout executive or designee Date Signature of Scout executive or designee Date
Registration fee
$ . Boys’ Life fee $ . APPLICANT COPY Retain on file for three years. 28-501E
Training for New Volunteers
Welcome to Scouting! As a new Scout volunteer, you are joining our Scouting family, and we want you to understand how the program works.
The Boy Scouts of America is committed to your success as a volunteer while serving young people. To help you be successful there are training materials designed for you.
Every Boy Deserves a Trained Leader
First things first! There are two types of training to begin your road to success. They are Fast Start Orientation, which presents a quick introduction to get new volunteers ready for your
first meeting or activity, and Youth Protection training.
What Is Youth Protection Training?
We seek to create as safe an environment as possible for young people to enjoy our program’s activities. The Boy Scouts of America Youth Protection training addresses strategies for per-
sonal safety awareness for youth as well as adults. Age-appropriate programs and DVD materials include:
• Youth Protection Guidelines: Training for Volunteer Leaders and Parents—Adults come away with a much clearer awareness of the kinds of abuse, the signs of abuse, and how to
respond and report should a situation arise.
• Youth Protection Guidelines: Training for Adult Venturing Leaders—Designed to give guidance to the leaders in our teenage coed Venturing program. Supervision and relationship
issues have a different focus regarding personal safety with this age group.
• It Happened to Me—Developed for Cub Scout–age boys from 6 to 10 years old and their parents. It addresses the four rules of personal safety: Check first, go with a friend, it’s your
body, and tell.
• A Time to Tell—A video for Boy Scout–age boys from 11 to 14 years old—the target group for most molesters. It stresses the three R’s of youth protection: Recognize, Resist, and Report.
• Youth Protection: Personal Safety Awareness—Developed for youth ages 14 through 20 in the coeducational Venturing program. It deals with issues pertinent to this age group.
The Boy Scouts of America has adopted these policies primarily for the
protection of our youth members; however, they also serve to protect our
adult volunteers and leaders from false accusations of abuse.
Two-deep leadership—No one-on-one contact—Respecting privacy—Reporting problems
So, How Do I Begin? Online or at Your Council Service Center!
Fast Start training for Cub Scout, Boy Scout, and Venturing leaders as well as Youth Protection training programs are available through your local council’s Web site and service center.
Online training is convenient. Your council’s Web site may have an icon for Youth Protection training, or you can check under “Training” or “Resources.”
Don’t know your council’s Web address? Go to http://olc.scouting.org and select the training that fits your needs.
You are expected to complete Youth Protection Guidelines: Training for Volunteer Leaders and Parents or, if you are involved in Venturing, Youth Protection Guidelines: Training for Adult
Venturing Leaders within the first 90 days of your registration.
What Makes a Trained Leader? (Check when completed)
® Youth Protection Guidelines
® Cub Scout leaders are considered trained when they have completed New Leader Essentials and the Cub Scout Leader Specific Training for their position.
® Scoutmasters and assistant Scoutmasters are considered trained when they have completed New Leader Essentials, Scoutmaster and Assistant Scoutmaster Leader Specific Training,
and Introduction to Outdoor Leader Skills.
® Troop committee members are considered trained when they have completed New Leader Essentials and the Troop Committee Challenge as their leader-specific training.
® Varsity Scout leaders and assistants are considered trained when they have completed New Leader Essentials, Varsity Scout Leader Specific Training, and Introduction to Outdoor
Leader Skills.
® Venturing crew Advisors, assistant Advisors, and crew committee members are considered trained when they have completed New Leader Essentials and Venturing Leader Specific
Training.
National Parent Initiative
The National Parent Initiative has been designed to increase youth and parent recruitment, retention, advancement, participation, dedication, and a passion for Scouting. Your involve-
ment and commitment is essential to the success of your child’s Scouting experience. We encourage the parents (guardians) for each child to:
1. Participate with them. 3. Be part of their unit’s program—both weekly meetings and outings. 5. Coach them on their advancement and earning of recognition awards.
2. Go to and observe their meetings. 4. Support the program financially. 6. Help in at least one support role during the year.