District Award of Merit Nomination

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NOTE: The nomination is confidential.

To avoid possible disappointment, please do not advise nominee in any way of your action in his or her behalf.

Your Name (making the nomination) *

Your Contact (making the nomination) *

Your email or phone number (in case we need to ask you a question)

Your Scouting Position (making the nomination) *

Your current scouting position

Name of Leader *

The person you are nominating for the award

Address of Leader *

The address of the person you are nominating for the award

Scouting Position of Leader (nominee) *

The current scouting position of the person you are nominating for the award

Scouting Unit of Leader (nominee) *

The current unit of the person you are nominating for the award (Pack / Troop number)

The nominee has earned the following *

Select all awards / achievements for the nominee

Den Le ader’s Training Award or Den Leader Award

Den Leader Coach’s Training Award or Den Leader Coach Award

Cubmaster Award

Cub Scouter Award

Webelos Den Leader Award

Scouter’s Training Award

Scouter’s Key

Scouter’s Religious Award

Silver Beaver

Order of the Arrow

Wood Badge

Venturing Awards

Other:

Required

Dates of the above checked awards *

The dates of the above selected awards / achievements

The noteworthy service upon which this nomination is based follows: *

(Furnish as much information as possible. For example: president, Rotary Club; vestryman, St. Paul’s Church; chairman, Red Cross campaign; vice-president, PTA; medical director, hospital; Cubmaster, 3 years; Scoutmaster, 4 years; Venturing Advisor, 3 years; commissioner, etc.)

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