Scouter Information Form Survey

The purpose of this form / electronic survey is different than the annual adult application form. This is to gather information about Scouters' years of service, training, and recognition/awards conferred. This is not mandatory, but will help the Commissioner significantly.

It may be completed by the individual, or another person on his/her behalf. Such information could be helpful in suitably recognizing the contribution of the Leader to Scouts Canada.

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1. Who are you?

Who are you? Name of Scouter
Name and phone number or email of the person competing this form (if different from the above).

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2. Where does the Scouter volunteer his/her time?

Where does the Scouter volunteer his/her time? Group Committee Beavers Cubs Scouts Venturers	Rovers Zone Service Team Area Service Team NS Council Service Team Trainer
Other or specific information

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3. Which Group is the Scouter currently registered with?

Which Group is the Scouter currently registered with?

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4. How long has s/he been a Leader with Scout's Canada?

How long has s/he been a Leader with Scout's Canada? first year Leader

1-5 years

6-10 years

11-15 years

16-20 years

21-25 years

26-30 years

Over 30 years (please specify)

5. Did the Scouter receive the latest long service recognition due, i.e. 5-yr pin, 10-yr medal, 15, 20, 25, 30-yr etc. pin?

Did the Scouter receive the latest long service recognition due, i.e. 5-yr pin, 10-yr medal, 15, 20, 25, 30-yr etc. pin? yes

not sure

6. What training has the Scouter taken?

	Woodbadge Training	Other Training
Colony	What training has the Scouter taken? Colony Woodbadge Training	Other Training
Pack	Pack Woodbadge Training	Other Training
Troop	Troop Woodbadge Training	Other Training
Company	Company Woodbadge Training	Other Training
Crew	Crew Woodbadge Training	Other Training
Service Team	Service Team Woodbadge Training	Other Training
Other	Other Woodbadge Training	Other Training

Other (please specify if not listed in drop-down menu)

7. If you are a trainer, what level?

If you are a trainer, what level? Trainer I

Trainer II

8. Has the Scouter received any awards?

Has the Scouter received any awards? Warrant of Appointment

Certificate of Commendation

Medal for Good Service

Medal of Merit

Bar to the Medal of Merit

Silver Acorn

Bar to the Silver Acorn

Silver Wolf

Medal of the Maple (received as a youth)

Jack Cornwell Decoration

Award for Fortitude

Bronze Cross for Gallantry

Bar to the Bronze Cross

Silver Cross for Gallantry

Bar to the Silver Cross

Gold Cross for Gallantry

Bar to the Gold Cross

Medal for Meritorious Conduct

Bar to the Medal for Meritorious Conduct

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9. Today's date:

	DD		MM		YYYY
This will help put a timeline on the information provided.	Today's date: This will help put a timeline on the information provided. Day	/	Month	/	Year

Thank you for completing this form. This information will be very helpful to your Commissioner.

Scouter Information FormExit this survey