| Ktemaque Lodge # 15 |
|---|
| OA Adult Nomination Form ________ (Date) |
|---|
| Name |
| Address |
| City | State | Zip |
| Occupation |
| Special Skills |
| Phone H(____)____________ | B(____)____________ |
Email address
|
| Date of birth _____/_____/_____ |
| is registered with | _ |
| (Troop#, Community) |
BSA Registration number
|
| Scouting position |
| Nominee has camped out |
| # | days and nights long term (6 consecutive days) |
| # |
days and nights short term (no more than 4 nights)
in the last 2 years under the auspices and standards
of the Boy Scouts of America |
| (List of camping dates and places must be included in the Letter of Recommendation.) |
| No. of boys elected from unit | Date MM/DD/YY |
| mm/dd/yy |
| I have spoken to the nominee and he has agreed to help in the following areas: |
| OA Service/Induction Weekends............ | _____ |
| Promote Camping.......................... | _____ |
| Serve as an OA Advisor................... | _____ |
| Help at Service weekends................. | _____ |
| I certify that the Nominee is a currently
registered Scouter and has served as a positive role model for the
growth and development of youth members of the Boy Scouts of America. I
also certify that the information listed on this form is true and
correct. |
| _____________________ | ______________________ |
| Unit Leader | Committee Chairman |
| Special Instructions: |
1.Adults are 21 years and older.
2. A letter of recommendation to the Lodge Selection Committee
must accompany this form. The letter must answer the following
questions:
- This adult will be an asset to the Order due to demonstrated skills and
abilities, which fulfill the purpose of the Order because:
- This adult leader's membership will provide a positive roll model
for the growth an development of the youth members of the Lodge because:
- Selection of the adult is based upon ability to perform the
requisite functions
(and NOT as an honor or recognition of service) including current or
prior achievement and position. The individual's abilities include:
- Please list camping dates and places within the past two years.
3. Mail both the form and the letter of recommendation to:
Ktemaque Lodge # 15
Adult Nomination
41 Saw Mill River Rd
Hawthorne, NY 10532-1519
|
All information requested must be supplied.
Adult nominations received after April 1st will not be considered. |
