Eagle Scout Media Info & Release
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- required
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Scout's full name:
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Age:
[Select One]
12
13
14
15
16
17
18
Or:
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Parents' or
guardians' names:
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Phone Number:
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Email Address:
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Address:
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City:
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Zip Code:
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Unit Type:
[Select One]
Troop
Team
Crew
Ship
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Unit Number:
Charter Organization:
School:
Grade:
[Select One]
6
7
8
9
10
11
12
College
Out of School Working Now
Date of Eagle Scout
award received:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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Eagle project
description:
(chars left:
1000
)
Number of merit
badges earned:
Leadership Positions:
Other Information:
(chars left:
1000
)
Please note that the maximum file size is 2 MB
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Eagle Scout Photo:
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Can we release the
information to the
local news media?:
Yes
No
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Image Verification:
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