Eagle Scout/Gold Award Project Application

Eagle Scout/Gold Award Project Application
Eagle Scout/Gold Award Applicant Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Birthdate:

MonthDayYear
Date
Year In School:
Parent/Guardian Name:

First NameLast Name
Parent Email:
example@example.com
Troop/Pack #:
Leader Name:

First NameLast Name
Leader Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Leader Email:
example@example.com
Name of Project:
Explain Project in Detail:
Proposed Project Start Date:

MonthDayYear
Date
Proposed Project End Date:

MonthDayYear
Date
Does this project pose any safety concerns? (Please note: the City may require insurance based on the scope of the project.)
If YES, please describe:
Who is going to monitor the safety of the project?
Who will provide safety equipment if needed?
Estimated Project Cost:
Estimated Amount From Fundraisers/Donations:
List Materials, Tools and Supplies Needed to Complete the Project:
Agreement/Signatures:

By signing below, I agree that I have read and am aware of the requirements to obtain my Eagle Scout/Gold Award from the Boy Scouts of America/Girl Scouts of the USA. I understand that if volunteers are required for the project that I will be responsible for recruiting, communicating and providing all information/documents to them. I understand that if my project is approved I will need to sign a waiver, hold harmless, relase of liabiltiy and may need to provide additional insurance.
Applicant Signature:
Parent/Guardian Signature:
Should be Empty: