American Veterinary Medical Association
Explorer Award Application

1. Post Information

Countil name and number______________________________________________________________________
Countil Address_____________________________________________________________________________
City__________________________ State__________________ Zip___________________
Chartered organization________________________________________________________________________
Chartered organization's address_________________________________________________________________
City__________________________ State__________________ Zip___________________
Post specialty_______________________________________________________________________________
Advisor's name________________________________________ Telephone number (_______)_________________
Advisor's address____________________________________________________________________________
City__________________________ State__________________ Zip___________________

2. Personal Information
Full name____________________________________________________________________________________
Address______________________________________________________________________________________
City__________________________ State__________________ Zip____________________
Age as of May 1 last year ______ Date of Birth _____/_____/_____ Telephone number (_____)_____________
Place of Birth_________________________________ State_________________________________________
Parent or guardian's name____________________________________________________________________
Languages spoken, other than English_________________________________________________________

3. Personal Achievements
A. List three significant project from any of the areas listed below in which you have been involved.

1)___________________________________________________________________________________________
2)___________________________________________________________________________________________
3)___________________________________________________________________________________________

B. What previous experience have you had in any of these areas? Give full deatils including dates, locations, project activities, etc.

C. List school and community organizations in which you are or have been active. Place a check by organizations in which you are currently active.

______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

D. List important award or recognitions you have received.

E. Scholastic record

High School name_____________________________________________________________________________
Class Size______________________ Rank in Class_______________________________________________
Attach a high school transcript or a statement from the school. College or university name (if applicable)_________________________ Grade-point average_________
F. Provide a simple, concise statement of your goals and career plans.
G. National nominee endorsement
(To be completed by the BSA local council Scout executive)

Council name and number____________________________________________________________________
Date application submitted_________________________________________________________________
Date forwarded to national office_________________________________________________________
Scout executive's signature_______________________________________________________________

This application and supporting material will be retained by the national Exploring Division of the Boy Scouts of America and must be submitted no later than June 1 of the yar in which the application is made.