VICTORIAN ROVER SCOUTS Application for the Presentation of the
Baden-Powell Scout Award
Part A: Personal Details
Membership No Region
Name NAME 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 Date Joey Scouts Cub Scouts Scouts Venturer Scouts Rover Scouts
yrs yrs Yrs yrs yrs
Part C: St George Award Details
Award Component & Details Date
Squire Training Badge completion Details
Rover Skills Badge completion Details
Physical Badge completion Details
Service Badge completion Details
Part D: Baden-Powell Scout Award Details
Award Component Date
St George Award completion Community Development Badge completion Details
Personal Growth Badge completion Details
Part E: Baden-Powell Scout Award Support Team – Self-Reflection Interview
Award Component Date
Self-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 – Notification
Name Position Signature Date
Part H: Victorian Rover Council – Endorsement
Name 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