EAGLE SCOUT SCHOLARSHIP INFORMATION FORM
This form, in addition to the Foundation’s Scholarship Application and letters of reference from Scout Leader
and a member of applicant’s community, school or church, is required in order to be considered for the Eagle
Scout Scholarship. Contact the Foundation at (989)875-4222 or at gccf@gratiotfoundation.org with questions.
Applicant’s Name:
Date of Birth:
Years in Scouting: Cub Scout:
Boy Scout:
Venturing:
Date Passed Eagle Board of Review:
BSA Unit No.:
Varsity/Sea Scouts:
NESA Member (circle one):
.
Yes or No .
Fill in—Troop, Team, Crew, Ship or Post:
Chartered Organization Name:
Chartered Organization Address:
City/State/Zip:
BSA Local Council Name:
Local Council Address:
City/State/Zip:
Dates of Gratiot County Boy Scout Troop Membership (minimum 24 months):
I. BSA Leadership Responsibilities (20 pts, 2 pts/position): Indicate those held by listing length of time served.
Leadership Position
Senior Patrol Leader
Asst. Sr. Patrol Leader
Patrol Leader
Asst. Patrol Leader
Jr. Asst. Scoutmaster
Den Chief
Scribe
Months Leadership Position
Librarian
Quartermaster
Instructor
Crew/Ship President
Crew/Ship Vice President
Crew/Ship Secretary
Varsity Team Captain
Months Leadership Position
OA Lodge Chief
OA Vice Lodge Chief
OA Lodge Secretary
Summer Camp Staff
Summer Camp CIT
Other
Other
Months
II. Merit Badges Earned (Maximum 15 pts.)
Number of Merit Badges Earned (over the 21 badges for Eagle Scout Rank):
(1 pt. for every 5 badges earned).
The following merit badges are given special consideration and should not be included in the above total. List
the date each badge was earned in the space provided (3 pts. each).
American Heritage:
Scouting Heritage
Scholarship
III. Order of the Arrow Involvement (Maximum 20 pts.) Check all that apply.
Ordeal Member (5 pts.):
Eagle Scout Scholarship Information
Brotherhood Member (10 pts.):
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Vigil Honor Member (5 pts.):
.
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IV. Scouting Religious Award Earned (5pts.): Yes or No
V. Significant Scouting Activities (Maximum 10 pts.) List all that apply (attach an additional page if
necessary). (e.g., Long-term Camping, Jamboree, Philmont, Venturing, OA-NOAC, OA Conclaves, OA
Fellowships, Polar Bears, OKPIK, etc.).
VI. Community Activities, Leadership and Recognitions (Maximum 10 pts.) Check all that apply. Exclude
religious, school or scout activities, leadership and recognitions.
CROP Walk
Other
Relay-for-Life
Other
Special Olympics Volunteer
Other
Red Cross Volunteer
Other
VII. Scholastic, School, and Extracurricular Activities, Leadership and Recognitions (Maximum 20 pts.)
List all that apply (attach an additional page if necessary).
IX. Hobbies and Special Interests (No points given, but intended to show the breadth of applicant’s interests
and talents.) List all that apply (attach an additional page if necessary).
The signatures below signify the information provided is complete and accurate.
Eagle Scout Applicant’s Signature:
Parent’s Signature:
Unit Leader’s Signature:
Eagle Scout Scholarship Information
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