Grand Lodge of Georgia F. & A. M.
EAGLE SCOUT AWARD APPLICATION
Name _________________________________________
As it appears on Eagle Scout Certificate
Address _______________________________________
Street or R.F.D. Address
___________________________________________
City, State, Zip Code
Telephone ____________ E-
_________________________ ___________________
Troop, Team, Crew or Ship Council
_____________________________________________
City, State, Zip Code
By Applicant: All statements on this application are true and correct.
Signature of Applicant________________________________________
Unit Approval: (personal signature)
Signature of Unit Leader______________________________________
Signature of Unit Committee Chair _______________________________
SA Local Council: According to the records of this council, the applicant is a registered member of this unit.
Signed_____________________________________
Position____________________
Eagle Scout Board of Review:
The applicant appeared before this board and the application was approved.
Signature Board Chair___________________________________________
Signature Council/District Representative______________________________
Scout Executive Approval ____________________________ Date_________
Signature
Mail completed form to: Grand Secretary
811 Mulberry St. Macon, GA 31201