Eagle Scout Media Info & Release

* - required

*Scout's full name:

*Age:

Or:

*Parents' or
guardians' names:

*Phone Number:

- -

Email Address:

*Address:

*City:

*Zip Code:

*Unit Type:

*Unit Number:

Charter Organization:

School:

Grade:

Date of Eagle Scout
award received:

/ /

*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

*Eagle Scout Photo:

*Can we release the
information to the
local news media?:

Yes
No

*Image Verification:

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