National Youth Leadership Training
Atlanta Area Council, Boy Scouts of America
1800 Circle 75 Parkway, SE
Atlanta, GA 30339
NYLT Scouter Staff Application
Scouter Information

First Name
* shows required information
*
Middle Initial *
Last Name *
Your Preferred Name *

Gender
Use M or F
*
Address
Street *
City *
State *
zip *

Home Telephone
Use format XXX-XXX-XXXX
*

Mobile Telephone
Use format XXX-XXX-XXXX
Email Address *

Date of Birth
format it as mm/dd/yyyy
*
Unit Information
Unit *
Unit Type *
District *
Present Position *
Attended High Adventure
     
 Philmont
     
 Sea Base
     
 Northern Tier
     
 Other
Number of years in Boy Scout Program

SM
How many years? 0 or more

ASM
How many years? 0 or more

Other
How many years? 0 or more
Personal Information
     
 Have any Physical, Medical, Dietary limitations or Restrictions?
Restrictions or Limitations
T-Shirt size *
Desired position to fill – check all that apply
     
 SM
     
 ASM – Program
     
 ASM – Service
     
 Support Staff
Your Availability

     
Pick at least one week
Week May 27-June 4
     
 Week June 4-11
     
 Week June 11-18
Any schedule conflicts we should know about?
How did you hear about this course and why do you want to participate?
How do you rate your working relationship with teenage scouts? *
The commitment includes: Dec 12, 2010 Staff Interviews, Jan22 Staff Orientation; Staff Development Weekends Feb 26, Mar 18-20, Apr 22-24, course set-up May 21, the full week of a course May 29-June 3, June 5-10 OR June 12-18 and for all final turn in of all equipment on Jun 18, 2011.
     
 Attended Wood Badge?
Course Number
Year
Location
     
 Staffed Wood Badge?
Course Number (any one)
Year
Location
Position
     
 Staffed JLTC / NYLT?
Position
Year(s)
Location(s)
     
 Attended NTLT SM Conference?
Year
Location
     
 Attended Trainer Development / Trainer EDGE?
Year
Location