VICTORIAN ROVER SCOUTSApplication for the Presentation of the

Baden-Powell Scout AwardPart A: Personal Details Membership No Region

NameNAME IN BLOCK LETTERS

Please ensure this is correct, as this is the name that will be inscribed on the certificate

Address

Suburb Postcode

Phone Mobile

Email Date of Birth

Part B: Scouting Details and Experience

Crew Group

District Investiture DateJoey Scouts Cub Scouts Scouts Venturer Scouts Rover Scouts

yrs yrs Yrs yrs yrs

Part C: St George Award DetailsAward Component & Details DateSquire Training Badge completionDetails

Rover Skills Badge completionDetails

Physical Badge completionDetails

Service Badge completionDetails

Part D: Baden-Powell Scout Award DetailsAward Component DateSt George Award completion

Community Development Badge completionDetails

Personal Growth Badge completionDetails

Part E: Baden-Powell Scout Award Support Team – Self-Reflection Interview Award Component DateSelf-Reflection Interview

Part F: Rover Crew Approval (please complete section below)I verify that the necessary qualifications as listed above have been completed and the Rover Crew recommends this applicant be awarded the Baden-Powell Scout Award

Name Position Signature Date

Part G: Region Rover Community – NotificationName Position Signature Date

Part H: Victorian Rover Council – EndorsementName Position Signature Date

Part I: State Chief Commissioner – Approval Name Signature Date

_________________________________________________________________________________________________________________________________________ Part J: Badge Return (Rover Crew to Complete)

Following the approval by the State Chief Commissioner the BPSA Badges and Certificate should be sent to the person listed below who will arrange for the presentation to the Rover Scout.

Name Position

Address

Suburb Postcode

Phone Mobile

Email_________________________________________________________________________________________________________________________________________ Part H: State Office Use Only

Date Applicant notified of outcome by Letter Date CL, RA, GL, DC and RC advised

(Must be after Applicant has been advised)Date Award noted on Extranet Record

Version 1, August 2014