BSP Form No. 17 (Rev.
07-24-12)
BOY SCOUTS OF THE PHILIPPINES
NATIONAL OFFICE
Manila
MERIT BADGE APPLICATION
Date _ _
(Date of Merit Badge Application is applied for)
I, EMERSON RUGAYAN hereby certify that I have been a holder of (Scout’s complete
name in block letters)
the OUTDOORSMAN since that I am a member of
(Present Scout Rank/Badge) (Date passed the Board of Review)
_ 2002 , Palayan City NHS ,_ Nueva Ecija _Council
(Troop / Outfit No.) (Sponsoring Institution)
and that I am qualified to work on the requirements for the MASONRY Merit Badge.
____EMERSON RUGAYAN _____
(Signature over Printed Name)
APPROVED: ARJAY E. ACOSTA
______________________________________________
(Signature over Printed Name of Troop Leader / Outfit Advisor)
NOTE: Upon signing this Merit Badge Application, the Troop Leader /Outfit Advisor recommends and sets an appointment with an accredited/certified Merit Badge
Counselor on specified dates of Merit Badge Counseling/Examination.
MERIT BADGE COUNSELING APPOINTMENT
Merit Badge Requirements / Projects Troop Leader/ Merit Badge Counselor Signature
Submitted and Completed Outfit Advisor
Date of 1st Meeting:
Date of 2nd Meeting:
Date of 3rd Meeting:
(Optional when
requirements are NOT
satisfied during the
2nd Meeting)
NOTE: This portion MUST filled-out by the Scout who appears before the Merit Badge Counseling/Examination and MUST be signed by the Troop Leader / Outfit Advisor and
the Merit Badge Counselor as proof of completion for Merit Badge requirements.
MERIT BADGE COUNSELOR’S COMPLETION CERTIFICATE
THIS IS TO CERTIFY that the above-named Scout personally appeared before the undersigned and that after a careful examination of
said Scout on the subject, has satisfactorily passed the test for ____ __
(Merit Badge Subject)
___________________________________ _____________________________
(Date Passed the Merit Badge Requirements) (Signature over Printed Name of Merit Badge Counselor)
NOTE: Do not examine Scout unless application is approved by the Troop Leader / Outfit Advisor. Only certified Advancement Counselors are authorized to sign
his certificate.