CATHOLIC COMMITTEE ON SCOUTING
LACROSSE DIOCESE
LACROSSE, WISCONSIN
RECOMMENDATION FOR THE: BRONZE PELICAN:
Name: ______________________________________________
Occupation: _________________________
Address: _____________________________
City: _____________________
State: ______ Zip: _________
Parish/Church: ______________________________________
Registered in Scouting as: __________________________
Council: _____________________
Unit #: ________________
Chartered By:_________________________________
Years of Service to Scouting: ________________
In the Diocese of LaCrosse: __________________
RECOMMENDED BY:
(1)Name: ____________________________________
Address: ___________________________________
State: ________ Zip: ________
Phone: (Home)_____________________
(Business)____________________
Signature: _______________________________________________
(2)Name: ____________________________________
Address: ___________________________________
State: ________ Zip: ________
Phone: (Home)_____________________
(Business)____________________
Signature: ________________________________________________
PARISH/CHURCH APPROVAL:
On (date) _________,
the candidate’s pastor (name) _________________________
approved the candidate as worthy of receiving this emblem.
Signed: ___________________________________________
DIOCESAN APPROVAL:
The St. George Selection Committee of the Diocese of LaCrosse certifies that the record of service of
this candidate has been carefully reviewed and that this candidate meets the requirements for this emblem
as approved by the Diocesan Catholic Committee on Scouting.
Date: _______________
Signed:(Chairman, Selection Committee)
__________________________________________
Date: _______________
Signed:(Diocesan Scout Chaplain)
___________________________________________
RECORD FOR DIOCESAN SCOUT CHAPLIN’S OFFICE:
Date Emblem Presented/Received: ________________
Emblem #: __________ By: ___________________
CATHOLIC COMMITTEE ON SCOUTING
LACROSSE DIOCESE
LACROSSE, WISCONSIN
RECOMMENDATION FOR THE: BRONZE PELICAN
RECORD OF CANDIDATE:
(Give pertinent facts dates, offices held. If more space is needed please add extra sheet.)
A. IN PARISH AND/OR DIOCESE:
B. IN BOY SCOUTS OF AMERICA (National, Council, District and/or Unit):
C. IN OTHER COMMUNITY ORGANIZATIONS (Activities in business, civic, religious, educational,
fraternal, and other fields):
D. LIST QUALIFICATIONS (As suggested by guidelines.):
NOTE: Nomination of a candidate is to be kept confidential. The committee or individual making the
recommendation will be notified of the results.