World Scouts Course Application
* Denotes Required Field.
NAME
*
Course Options:
Base Camp: Community-based Learning
Change your World
PERMANENT STREET ADDRESS
CITY
STATE
ZIP
COUNTRY
*
HOME PHONE
*
CELL PHONE
EMAIL
*
DATE OF BIRTH
*
GENDER
*
Male
Female
U.S. CITIZEN
Yes
No
ETHNICITY
Non-Resident
White / Caucasian
Black / African America
American Indian / Alaska Native
Hispanic / Latino
Asian
Native Hawaiian / Other Pacific Islander
Other
TROOP/UNIT NUMBER YOU ARE ASSOCIATED WITH
*
SCOUT COUNCIL/DISTRICT
*
REGION
WHATSAPP/SKYPE
NAME OF PERSON WHO CAN VERIFY YOUR ASSOCIATION
*
EMAIL OF THE PERSON ABOVE
*
NAME OF PERSON WHO CAN VERIFY YOUR ASSOCIATION
*
EMAIL OF THE PERSON ABOVE
*
DECLARATION
*
I agree that by Checking this box and submitting this form that all information is accurate to the best of my knowledge.
Submit
