Central Florida Council, B.S.A.
Lynette K. Dukes, Eagle Registrar
Wayne Densch Boy Scout Service Center
1951 South Orange Blossom Trail, Suite 102
Apopka, FL 32703-7747
(407) 703-0225
Lynette.Dukes@Scouting.org
BSA LOCAL COUNCIL CERTIFICATION
Central Florida Council
Eagle Scout Rank Application Checklist
Please do NOT submit this checklist with the Eagle Scout Rank Application
Name of Life Scout ___________________________________________
Unit & Number _____________________
Date ___________________
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PRINT IN INK OR TYPE ALL INFORMATION
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Use the most recent Eagle Scout Rank Application (currently 2014 printing). You may find this form at the following links:
http://www.scouting.org/scoutsource/Media/forms.aspx OR http://www.nesa.org/ OR
http://www.cflscouting.org/Leaders/Advancement/BoyScout/EagleScoutInformation/tabid/473/Default.aspx.
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All information is legible (typed if possible).
Page 1
FOR COUNCIL USE ONLY box (right side)
COUNCIL NO. = 083
REGION = S
TYPE OF UNIT = Troop or Crew or Team or Ship
NATIONAL NUMBER = Unit Number & District Number (ie. Troop 22 = 22 D-9)
D-1 = Little Econ District
D-2 = Lake District
D-3 = Tuscarora District
D-4 = Three Rivers District
D-5 = Riverside District
D-6 = Fort Gatlin District
D-7 = Challenger District
D-8 = Osceola District
D-9 = Apopka Shores District
D-10 = Seminole Springs District
D-27 = Sand Lake District
PID NO. (REQUIRED) = Person ID Number located on top left hand corner of Eagle Scout Form screen shot.
Page 1 (left side)
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Applicant=s complete legal name (including middle name and any applicable suffix such as “Jr.”, “III”, etc. and enter your
correct mailing address, telephone number and Email Address. No abbreviations.
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Unit type (Troop, Team, Crew or Ship), local number, and location of unit are entered. No abbreviations.
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Date became a Boy Scout is entered (date joined a troop).
Eagle Scout Rank Application Checklist & Intake Form – BSA Local Council Certification
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Date became a Varsity Scout is entered (if applicable).
Date became a Venturer is entered (if applicable).
Date of First Class Scout board of review entered.
Date of Star Scout board of review entered. Star rank requires at least 4 months membership as a First Class Scout.
Cub Scout, Webelos Scout, Arrow of Light, and fifth grade questions answered (Yes or No). NOTE: Usually, if ‘Yes’ is
answered to being a “Webelos Scout?” and ‘Yes’ is answered to earning the “Arrow of Light?”, then ‘No’ is answered to
“Completed 5th grade?” (since crossover is usually during 5th grade).
Requirement 1 – Life Scout
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Be active in your troop, team crew, or ship for a period of at least six months after you have achieved the rank of Life
Scout. Enter the date of your Life Scout board of review (mm/dd/yy).
Requirement 2 - References
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All references are listed on the application. (No blank spaces allowed) All references and their information should be filled
out on the Eagle Scout Rank Application, with the exception of the Employer. If no employer, then put none or n/a for not
applicable. If the Scout does not go to church and cannot provide a religious reference, the parent(s) name and
information must be listed on that line. If the Scout is home-schooled, the parent(s) name and information must be listed
on the educational reference line.
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The Board Chairperson (or the Unit designee) has received a letter of reference from or checked to ensure that one is
forthcoming from each of the individuals listed on the application. (Do not turn in the letters with the Application.)
Requirement 3 – Merit Badges
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21 merit badges are listed with date and unit number on each:
1. Request via email an Eagle Scout Form from the Eagle Registrar giving your full name, date of birth and unit you are
registered with.
2. Make certain that the rank and merit badge dates on your Eagle Scout Rank Application match the dates that are on the
Eagle Scout Form identically.
3. The Optional Merit Badges on the Eagle Scout Rank Application must be listed in chronological order exactly as they are
listed on the Eagle Scout Form (DO NOT SKIP ANY MERIT BADGES).
4. For any ranks that are missing or different from your records at Council, please provide copies of your rank cards to the
Eagle Registrar.
5. For any merit badges that are missing or different from your records at Council, please provide copies of the Applicant’s
Record side of your merit badge blue cards to the Eagle Registrar.
6. Make certain that the dates on your Eagle Scout Rank Application match identically the dates on the documentation that
you provide for ranks or merit badges.
7. If your unit uses Internet Advancement and your advancements have been entered in ScoutNet via Internet Advancement
by your unit’s Advancement Chair, then no other documentation is necessary when submitting your Eagle Scout Rank
Application, so long as the dates on your application match those on file at Council shown on the Eagle Scout Form.
8. A Troopmaster Individual History Report is not an Advancement Report and will not be accepted as such. The accepted
forms of documentation for merit badges are as follows:
a.
Completed Application for Merit Badge (Applicant’s Record side of Merit Badge Blue Card) – No. 34124
b.
Completed Merit Badge Award Card – No. 34393
c.
Completed Internet Advancement Report
The accepted forms of documentation for ranks are as follows:
a.
Completed pocket-size Rank Card – (ie.; 1st Class – No. 33053, Star – No. 33054, Life – No. 33055, etc.)
b.
Completed Internet Advancement Report
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On merit badge lines 7, 8 and 10, you should draw a line through the merit badges that do not apply. If any of the
marked off merit badges are to be counted as part of the 21 total merit badges, the badges must be put in one of the other
boxes (14 through 21).
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Enter the Unit Number from which the merit badge was earned next to the date earned of each merit badge.
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4 Eagle required merit badges have a date prior to the Star Scout board of review date. Credit may be given if the Scout
earned both Emergency Preparedness and Lifesaving or any combination of Swimming, Hiking, and Cycling.
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2 additional merit badges must have a date prior to the Star Scout board of review date.
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3 Eagle required merit badges have a date prior to the Life Scout board of review. These Eagle required merit badges are
in addition to the ones earned for Star Scout rank. Credit may be given if the Scout earned both Emergency Preparedness
and Lifesaving or any combination of Swimming, Hiking, and Cycling, as long as they are not used for credit for Star Scout
rank.
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2 additional merit badges must have a date prior to the Life Scout board of review date. These merit badges are in
addition to those earned for Star Scout rank.
Page 2
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Applicant=s complete legal name (including middle name and any applicable suffix such as “Jr.”, “III”, etc. entered at the
top of the page).
Requirement 4 – Life Scout Positions of Responsibility
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Date of Life Scout board of review entered on second page of the application and matches the Life Scout board of review
date on the front page.
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Scout must have served in a qualified position of leadership (see Eagle Scout Rank Application for qualified positions) for at
Eagle Scout Rank Application Checklist & Intake Form – BSA Local Council Certification
least 6 months between the Life Scout board of review and the Eagle Scout Rank Application date and before the
candidates 18th birthday. List only those positions served after Life board of review date.
NOTE: Chaplain Aide Qualifications
1.
The chaplain aide must be mature and sensitive and have earned the respect and trust of his fellow Scouts.
2.
The chaplain aide must be at least a First Class Scout.
3.
The chaplain aide must have received or be working on the requirements leading to the age-appropriate
religious emblem for his faith.
Requirement 5 – Eagle Scout Service Project
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Project completion date entered is the same as the date in the project workbook. Date must be between Life Scout board
of review and Eagle Scout application dates and before applicant=s 18th birthday. Also include Project Name and Grand
Total of Hours (Total Hours from the top of Page 20 of the Eagle Scout Leadership Service Project Workbook).
Requirement 6 – Scoutmaster Conference
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Take part in a unit leader conference and enter the date the conference was held – date must be before the Scout’s 18th
birthday.
Requirement 7 – Statement of Ambitions & Life Purpose
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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.
CERTIFICATION BY APPLICANT:
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Applicant=s signature, applicant=s telephone number, and date signed entered.
UNIT APPROVAL:
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Unit leader=s signature, unit leader=s telephone number, and date signed entered.
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Unit committee chair=s signature, unit committee chair=s telephone number, and date signed entered.
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Eagle Scout Leadership Service Project Workbook was signed and dated by unit leader and unit committee chair after
project was completed.
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Completed Eagle Scout Service Project Workbook is not turned in with the Eagle Scout Rank Application.
BSA LOCAL COUNCIL CERTIFICATION –
***Eagle Scout Rank Applications must be turned in for BSA Local Council Certification no later than the Scout’s 18th Birthday.
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Please allow up to two (2) weeks for BSA Local Council Certification approval and six (6) to eight (8) weeks for Eagle
Certificates from National.
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Please submit the following documents when requesting BSA Local Council Certification:
1.
Original Eagle Scout Rank Application – 2014 Printing
2.
Life Purpose Statement – Requirement 7
3.
Copy of Project Completion Approval Signatures - Page 20 from Project Workbook
4.
Intake Form – BSA Local Council Certification
Please do NOT include your Eagle Scout Leadership Service Project Workbook.
EAGLE BOARD OF REVIEW:
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Only after you have received BSA Local Council Certification may you proceed and schedule your Eagle Scout Board of
Review. Please contact only the District Advancement Chair or District Eagle Chair from your District.
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Complete the Eagle Checklist and Intake Form Following Eagle Board of Review
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Complete the NESA Service Project Information Form
Immediately following your Eagle Board of Review, return the four (4) documents listed on the Eagle Checklist and Intake Form
Following Eagle Board of Review to the Central Florida Council Eagle Scout Registrar, no later than one (1) week following your
Eagle Board of Review date. Please do NOT include your Eagle Scout Leadership Service Project Workbook.
BSA Local Council Certification
Intake Form
Central Florida Council, B.S.A.
Lynette K. Dukes, Eagle Registrar
(407) 703-0225
Lynette.Dukes@cflscouting.org
Please find attached the following for ________________________ (Scout’s Name) of
______________ (Unit & Number):
___X___
Original Eagle Scout Rank Application for BSA Local Council Certification, Project
Completion Signature Page from Project Workbook – Page 20 (attached) & Requirement 6 –
Life Purpose Statement (attached)
D:\116103565.DOC
Please email _________________ (name) at _____________________ (email address) when
this is ready to be picked up.
OR
Mail to: _____________________________ (name)
_____________________________ (address)
_____________________________ (city, state, zip code)
D:\116103565.DOC